title: Significance of admission hypoalbuminemia in acute intracerebral hemorrhage.
abstract: Low levels of serum albumin may increase the risk of infections and mortality in critically ill patients. We tested the hypothesis that admission hypoalbuminemia predicted infectious complications and poor outcome in subjects with acute intracerebral hemorrhage (ICH). We analyzed a single center cohort of ICH patients collected between 1994 and 2015. Pneumonia, urinary tract infection and sepsis were retrospectively identified, according to validated criteria. Serum albumin was measured on admission and hypoalbuminemia was defined as total albumin ≤3.5 g/dL. The association between albumin levels, infections, and mortality at 90 days was tested with multivariable logistic regression analyses. A total of 2010 patients were included (median age 74 years, 54.5% males) of whom 444 (22.1%) had hypoalbuminemia on admission and 763 (38%) died within 90 days. The frequency of pneumonia, urinary tract infection, and sepsis was 19.9, 15.1, and 2.7%, respectively. Hypoalbuminemic patients had lower admission Glasgow coma scale, higher frequency of intraventricular hemorrhage and were more likely to have a history of chronic kidney or liver disease. After adjustment for potential confounders, hypoalbuminemia was an independent predictor of pneumonia [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.34-2.33, p < 0.001] and sepsis (OR 2.29, 95% CI 1.22-4.30, p = 0.010). Low levels of albumin were also independently associated with higher mortality at 90 days (OR 1.78, 95% CI 1.30-2.44, p < 0.001). In conclusion, early hypoalbuminemia is common and predicts poor outcome in ICH patients. Increased susceptibility to pneumonia and sepsis may be the pathophysiological mechanism underlying this association.
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA. a.morotti@ymail.com.|J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA. a.morotti@ymail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Morotti
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA.|J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Sandro
authors.initials: S
authors.lastname: Marini
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Umme K
authors.initials: UK
authors.lastname: Lena
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Crawford
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Kourkoulis
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Ayres
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: M
authors.initials: M
authors.lastname: Edip Gurol
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA.|J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Anderson
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA.|J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, USA.|J. P. Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, 175 Cambridge Street, Suite 300, Boston, MA, 02114, USA.|Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, USA.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000150:complications* / Q000000981:diagnostic imaging; D015331:Cohort Studies; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D012709:Serum Albumin / Q000378:metabolism*; D018709:Statistics, Nonparametric; D014552:Urinary Tract Infections / Q000150:complications / Q000209:etiology / Q000401:mortality
chemical_list: D012709:Serum Albumin
keywords: Albumin; Intracerebral hemorrhage; Outcome; Pneumonia; Sepsis; Stroke