Serum albumin level is associated with the recurrence of acute ischemic stroke



      Previous studies have confirmed that low serum albumin levels in acute ischemic stroke patients increased the risk for poor outcome and death, demonstrating the neuroprotective role of albumin. However, there are few studies investigating the relationship between albumin levels and recurrence of stroke. The aim of this study was to evaluate the effect of serum albumin level on the risk of recurrence in patients with acute ischemic stroke.


      Seven hundred fifty-three consecutive patients with acute first-ever ischemic stroke were recruited in this study. Recurrent outcome was measured 1 year after stroke through home interviews (n = 692).


      Patients with recurrence had significantly lower serum albumin level than those without recurrence (37.07 ± 4.21 vs 38.91 ± 3.25). The multiple logistic regression adjustment for confounding factors showed that the association remained significant for patients in the second albumin quartile, the third quartile, and the fourth quartile compared with patients in the first quartile (adjusted odds ratio [aOR] = 0.543, 95% confidence interval [CI]: 0.307-0.959, P= .036; aOR = 0.449, 95% CI: 0.249-0.812, P= .008; and aOR = 0.290, 95% CI: 0.148-0.570, P < .001).


      Lower serum albumin level increases the risk of recurrence in patients with acute ischemic stroke, suggesting that serum albumin level might be used as an indicator for stroke recurrence.
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        • Feigin VL
        • Forouzanfar MH
        • Krishnamurthi R
        • et al.
        Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010.
        Lancet. 2014; 383: 245-254
        • Ginsberg MD
        • Palesch YY
        • Hill MD
        • et al.
        High-dose albumin treatment for acute ischaemic stroke (ALIAS) part 2: a randomised, double-blind, phase 3, placebo-controlled trial.
        Lancet Neurol. 2013; 12: 1049-1058
        • Sutherland BA
        • Minnerup J
        • Balami JS
        • et al.
        Neuroprotection for ischaemic stroke: translation from the bench to the bedside.
        Int J Stroke. 2012; 7: 407-418
        • Belayev L
        • Liu Y
        • Zhao W
        • Busto R
        • Ginsberg MD
        Human albumin therapy of acute ischemic stroke: marked neuroprotective efficacy at moderate doses and with a broad therapeutic window.
        Stroke. 2001; 32: 553-560
        • Belayev L
        • Zhao W
        • Pattany PM
        • et al.
        Diffusion-weighted magnetic resonance imaging confirms marked neuroprotective efficacy of albumin therapy in focal cerebral ischemia.
        Stroke. 1998; 29: 2587-2599
        • Chen J
        • Fredrickson V
        • Ding Y
        • et al.
        Enhanced neuroprotection by local intra-arterial infusion of human albumin solution and local hypothermia.
        Stroke. 2013; 44: 260-262
        • Phillips A
        • Shaper AG
        • Whincup PH
        • et al.
        Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes.
        Lancet. 1989; 16: 1434-1436
        • Babu MS
        • Kaul S
        • Dadheech S
        • et al.
        Serum albumin levels in ischemic stroke and its subtypes: correlation with clinical outcome.
        Nutrition. 2013; 29: 872-875
        • Djoussé L
        • Rothman KJ
        • Cupples LA
        • et al.
        Serum albumin and risk of myocardial infarction and all-cause mortality in the Framingham offspring study.
        Circulation. 2002; 106: 2919-2924
        • Dziedzic T
        • Slowik A
        • Szczudlik A
        Serum albumin level as a predictor of ischemic stroke outcome.
        Stroke. 2004; 35: 156-158
        • Chakraborty B
        • Vishnoi G
        • Goswami B
        • et al.
        Lipoprotein(a), ferritin, and albumin in acute phase reaction predicts severity and mortality of acute ischemic stroke in north Indian patients.
        J Stroke Cerebrovasc Dis. 2013; 22: 159-167
      1. The Neuroscience Society (1996). All kinds of cerebrovascular disease diagnosis points.
        Chin J Neurol. 1996; 29: 379
        • Morris DL
        • Rosamond W
        • Madden K
        • Schultz C
        • Hamilton S
        Prehospital and emergency department delays after acute stroke: the Genentech stroke presentation survey.
        Stroke. 2000; 31: 2585-2590
        • Working Group on obesity in China
        Recommendations on the category of body mass index in Chinese adults.
        Chin J Prev Med. 2001; 35: 349-350
        • Famakin B
        • Weiss P
        • Hertzberg V
        • et al.
        Hypoalbuminemia predicts acute stroke mortality: Paul Coverdell Georgia stroke registry.
        J Stroke Cerebrovasc Dis. 2010; 19: 17-22
        • Vahedi A
        • Lotfinia I
        • Sad RB
        • et al.
        Relationship between admission hypoalbuminemia and inhospital mortality in acute stroke.
        Pak J Biol Sci. 2011; 14: 118-122
        • Hardie K
        • Hankey GJ
        • Jamrozik K
        • Broadhurst RJ
        • Anderson C
        Ten-year risk of first recurrent stroke and disability after first ever stroke in the Perth community stroke study.
        Stroke. 2004; 35: 731-735
        • Abubakar S
        • Sabir A
        • Ndakotsu M
        • et al.
        Low admission serum albumin as prognostic determinant of 30-day case fatality and adverse functional outcome following acute ischemic stroke.
        Pan Afr Med J. 2013; 14: 53
        • Hankey GJ
        • Jamrozik K
        • Broadhurst RJ
        • et al.
        Diabetes is an independent risk factor for stroke recurrence in stroke patients: a meta-analysis.
        J Stroke Cerebrovasc Dis. 2015; 24: 1961-1968
        • Mather KJ
        • Steinberg HO
        • Baron AD
        Insulin resistance in the vasculature.
        J Clin Invest. 2013; 123: 1003-1004
        • Capes SE
        • Hunt D
        • Malmberg K
        • et al.
        Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview.
        Stroke. 2001; 32: 2426-2432
        • Bologa RM
        • Levine DM
        • Parker TS
        • et al.
        Interleukin-6 predicts hypoalbuminemia, hypocholesterolemia, and mortality in hemodialysis patients.
        Am J Kidney Dis. 1998; 32: 107-114
        • Dominioni L
        • Dionigi R
        Immunological function and nutritional assessment.
        JPEN J Parenter Enteral Nutr. 1987; 11: 70-72
        • Quinlan GJ
        • Martin GS
        • Evans TW
        Albumin: biochemical properties and therapeutic potential.
        Hepatology. 2005; 41: 1211-1219
        • Yoo SH
        • Kim JS
        • Kwon SU
        • et al.
        Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients.
        Arch Neurol. 2008; 65: 39-43
        • Aptaker RL
        • Roth EJ
        • Reichhardt G
        • et al.
        Serum albumin level as a predictor of geriatric stroke rehabilitation outcome.
        Arch Phys Med Rehabil. 1994; 75: 80-84
        • Park HP
        • Nimmagadda A
        • DeFazio RA
        • et al.
        Albumin therapy augments the effect of thrombolysis on local vascular dynamics in a rat model of arteriolar thrombosis: a two-photon laser-scanning microscopy study.
        Stroke. 2008; 39: 1556-1562
        • Belayev L
        • Pinard E
        • Nallet H
        • et al.
        Albumin therapy of transient focal cerebral ischemia: in vivo analysis of dynamic microvascular responses.
        Stroke. 2002; 33: 1077-1084
        • Rodriguez de Turco EB
        • Belayev L
        • Liu Y
        • et al.
        Systemic fatty acid responses to transient focal cerebral ischemia: influence of neuroprotectant therapy with human albumin.
        J Neurochem. 2002; 83: 515-524
        • Alvarez-Perez FJ
        • Castelo-Branco M
        • Alvarez-Sabin J
        Albumin level and stroke. Potential association between lower albumin level and cardioembolic aetiology.
        Int J Neurosci. 2011; 121: 25-32
        • Reinhart WH
        • Nagy C
        Albumin affects erythrocyte aggregation and sedimentation.
        Eur J Clin Investig. 1995; 25: 523-528
        • Belayev L
        • Busto R
        • Zhao W
        • et al.
        Effect of delayed albumin hemodilution on infarction volume and brain edema after transient middle cerebral artery occlusion in rats.
        J Neurosurg. 1997; 87: 595-601
        • Liu Y
        • Belayev L
        • Zhao W
        • et al.
        Neuroprotective effect of treatment with human albumin in permanent focal cerebral ischemia: histopathology and cortical perfusion studies.
        Eur J Pharmacol. 2001; 428: 193-201