title: Persistent hypoalbuminemia is a predictor of outcome in cervical spinal cord injury.
abstract: BACKGROUND
  Hypoalbuminemia is associated with increased morbidity and mortality in various clinical settings and several major diseases. Albumin has multiple physiologic properties that could be beneficial in central nervous system injury.
  
  
  OBJECTIVE
  We sought to determine if albumin is associated with patient outcome after cervical spinal cord injury by conducting a retrospective analysis.
  
  
  METHODS
  A retrospective study of cervical spinal cord injury (CSCI) patients was conducted to investigate if serum albumin levels and other characteristics influence outcome (mechanical ventilation and death).
  
  
  METHODS
  A total of 178 consecutive patients were included in the present study.
  
  
  METHODS
  Demographic data were recorded, including age, gender, smoking history, time from injury to admission, severity of neurologic injury, neurologic level of lesion, mechanism of neurologic injury, Glasgow Coma Score, vitals in the Orthopedic Department, the occurrence of early surgical intervention (48 hours after injury), and daily serum albumin levels.
  
  
  METHODS
  No funds were received in support of this work. No specific conflicts of interest were involved in this article. Serum albumin levels and other characteristics known to influence outcome were included in univariate statistical analyses and the multiple logistic regression model to analyze the relationship with mechanical ventilation and death after cervical injury.
  
  
  RESULTS
  Approximately 41.0% (73/178) of patients had complete spinal cord injury (ASIA A), 36.5% (65/178) of patients required mechanical ventilation, and 8.4% (15/178) of patients died within the first month after injury. Albumin remained lower than 30 g/L for a period of time (≥5 days) in patients with an unfavorable outcome (patients requiring mechanical ventilation or who had died). Multiple logistic regression analysis identified age (>50 years), persistent hypoalbuminemia (<30 g/L and ≥5 days), C5 and above neurologic injury, and ASIA A as predictors for mechanical ventilation. In addition, persistent hypoalbuminemia, ASIA A, and C4 and above neurologic injury were significantly associated with death.
  
  
  CONCLUSIONS
  Similar to the ASIA scale and neurologic level, persistent hypoalbuminemia seems to be an independent predictor of outcome in patients with CSCI. Thus, a randomized trial assessing albumin in the treatment of cervical spinal cord injury is warranted.
authors.affiliation: Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang City, 36# Sanhao Street, Heping District, Liaoning Province 110004, P.R. China.
authors.forename: Guo-Xin
authors.initials: GX
authors.lastname: Jin
authors.affiliation: Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang City, 36# Sanhao Street, Heping District, Liaoning Province 110004, P.R. China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang City, 36# Sanhao Street, Heping District, Liaoning Province 110004, P.R. China.
authors.forename: Shao-Qian
authors.initials: SQ
authors.lastname: Cui
authors.affiliation: Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang City, 36# Sanhao Street, Heping District, Liaoning Province 110004, P.R. China.
authors.forename: Jing-Zhu
authors.initials: JZ
authors.lastname: Duan
authors.affiliation: Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Shenyang City, 36# Sanhao Street, Heping District, Liaoning Province 110004, P.R. China. Electronic address: 34332647@qq.com.
authors.forename: Huan
authors.initials: H
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D066193:Cervical Cord / Q000293:injuries; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000378:metabolism; D013119:Spinal Cord Injuries / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D012709:Serum Albumin
keywords: Albumin; Cervical spinal cord injury (CSCI); Death; Edema; Hypoalbuminemia (HA); Risk factor