Background: Animal studies show a neuroprotective effect of serum albumin in ischemic stroke. The neuroprotective effect of albumin in ischemic stroke in humans is not well studied. This study was aimed to determine the association of serum albumin with outcome and mortality after ischemic stroke. Methods: In a prospective study, we included 444 patients with ischemic stroke. Serum albumin was measured at the time of admission. Stroke severity was measured at the time of admission with the National Institutes of Health Stroke Scale (NIHSS). Functional outcome was measured with the modified Rankin scale (mRS) on day 7. Multiple logistic regression analysis was used to assess the independent association between variables and outcome. Survival was analyzed by Cox regression analysis after adjusting for age, sex and NIHSS score on admission. Results: The mean age (SD) of the patients was 70.4 (14.4) years. The median NIHSS score (interquartile range) on admission was 4 (1–8) and the median mRS score (interquartile range) on day 7 was 2 (1–3). Sixty patients (13%) died during a median follow-up period of 2 years. High serum albumin was independently associated with a better outcome (OR = 1.12, 95% CI = 1.05–1.20, p = 0.001). After adjusting for age, sex and NIHSS score on admission, high serum albumin was associated with lower mortality (OR = 0.88, 95% CI = 0.83–0.93, p < 0.0001). Conclusions: The current study indicates that high serum albumin is associated with better outcome and lower mortality in ischemic stroke patients. High serum albumin may be neuroprotective in ischemic stroke in humans.

Keywords:
Ischemic stroke, Serum albumin, Neuroprotection
1.
Ferro JM, Davalos A: Other neuroprotective therapies on trial in acute stroke. Cerebrovasc Dis 2006;21(suppl 2):127–130.
2.
Belayev L, Pinard E, Nallet H, Seylaz J, Liu Y, Riyamongkol P, Zhao W, Busto R, Ginsberg MD: Albumin therapy of transient focal cerebral ischemia: in vivo analysis of dynamic microvascular responses. Stroke 2002;33:1077–1084.
3.
Belayev L, Busto R, Zhao W, Clemens JA, Ginsberg MD: 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.
4.
Dziedzic T, Slowik A, Szczudlik A: Serum albumin level as a predictor of ischemic stroke outcome. Stroke 2004;35:e156–e158.
5.
Wahlgren N, Ahmed N, Davalos A, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Kuelkens S, Larrue V, Lees KR, Roine RO, Soinne L, Toni D, Vanhooren G: Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007;369:275–282.
6.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526.
7.
Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE III: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
8.
Toni D, Chamorro A, Kaste M, Lees K, Wahlgren NG, Hacke W: Acute treatment of ischaemic stroke. European Stroke Initiative. Cerebrovasc Dis 2004;17(suppl 2):30–46.
9.
Reinhart WH, Nagy C: Albumin affects erythrocyte aggregation and sedimentation. Eur J Clin Invest 1995;25:523–528.
10.
Park HP, Nimmagadda A, DeFazio RA, Busto R, Prado R, Ginsberg MD: 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.
11.
Palesch YY, Hill MD, Ryckborst KJ, Tamariz D, Ginsberg MD: The ALIAS Pilot Trial: a dose-escalation and safety study of albumin therapy for acute ischemic stroke – II: neurologic outcome and efficacy analysis. Stroke 2006;37:2107–2114.
12.
Halliwell B: Albumin – an important extracellular antioxidant? Biochem Pharmacol 1988;37:569–571.
13.
Parkkinen J, Ojala P, Niiranen J, Jolkkonen J: Molecular mechanisms underlying neuroprotective effects of albumin after ischemic stroke. Stroke 2007;38:255.
14.
Huh PW, Belayev L, Zhao W, Busto R, Saul I, Ginsberg MD: The effect of high-dose albumin therapy on local cerebral perfusion after transient focal cerebral ischemia in rats. Brain Res 1998;804:105–113.
15.
Shin DH, Moon GJ, Bang OY: Albumin therapy in acute stroke patients. J Neurol 2007;254:870–878.
16.
Koch S, Concha M, Wazzan T, Romano JG, Forteza A: High dose human serum albumin for the treatment of acute ischemic stroke: a safety study. Neurocrit Care 2004;1:335–341.
17.
Yoo SH, Kim JS, Kwon SU, Yun SC, Koh JY, Kang DW: Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Arch Neurol 2008;65:39–43.
18.
Ali M, Atula S, Bath PM, et al: Stroke outcome in clinical trial patients deriving from different countries. Stroke 2009;40:35–40.
19.
Davalos A, Ricart W, Gonzalez-Huix F, Soler S, Marrugat J, Molins A, et al: Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996;27:1028–1032.
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2009
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