Abstract 15189: Association of Serum Albumin Levels and Post Stroke Outcomes in Acute Ischemic Stroke. Analysis of the Norfolk and Norwich Stroke Registry

Abstract

Introduction: Low serum albumin levels have been associated with poor acute ischemic stroke (AIS) outcomes. We hypothesised this relationship may be non-linear and aimed to assess it in a large cohort of unselected AIS patients with long term follow-up. Method: This retrospective cohort study included patients from the Norfolk and Norwich Stroke and TIA Register: consecutive AIS patients aged ≥40 years from Dec 2003-Dec 2016 with complete follow-up data. The primary exposure of interest was admission serum albumin. Assessed outcomes were in-hospital mortality, poor functional outcome at discharge (modified Rankin score of 3-6), length of stay (LoS) >4 days and long-term mortality. Poisson and Cox regressions were used to investigate the relationship between albumin and in-hospital and long-term outcomes, respectively. Restricted cubic splines modelled these relationships flexibly. All models were adjusted for confounders, including inflammatory markers on admission and stroke severity. Results: A total of 9,979 patients were included (mean age (standard deviation) = 78.3 (11.2) years, 57% female). The mean serum albumin was 36.69g/L (5.38); the median (IQR) was 37g/L (34-40). Lower-than-median albumin (<37g/L) was significantly associated with up to 2-fold higher long-term mortality risk (HR max ; 95% confidence interval = 2.01; 1.61-2.49) and in-hospital mortality (RR max ; 95% confidence interval = 1.48; 1.21-1.80). Higher-than-median albumin (>44g/L) was associated with higher long-term mortality (HR max 1.12; 1.06-1.19), but not in-hospital mortality. There were no significant associations between admission albumin and LoS or poor functional outcome ( Figure ). Conclusion: Albumin <37g/L was associated with higher in-hospital and long-term mortality whilst levels >44g/L were associated with higher long-term mortality. Future studies should explore nutritional interventions for better stroke outcomes.