TY - JOUR
T1 - Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage
AU - the MNEMONICH Investigators
AU - Di Napoli, Mario
AU - Behrouz, Réza
AU - Topel, Christopher H.
AU - Misra, Vivek
AU - Pomero, Fulvio
AU - Giraudo, Alessia
AU - Pennati, Paolo
AU - Masotti, Luca
AU - Schreuder, Floris H.B.M.
AU - Staals, Julie
AU - Klijn, Catharina J.M.
AU - Smith, Craig J.
AU - Parry-Jones, Adrian R.
AU - Slevin, Mark A.
AU - Silver, Brian
AU - Joshua, Willey Z.
AU - Azarpazhooh, Mahmoud R.
AU - Vallejo, Jaime Masjuán
AU - Nzwalo, Hipólito
AU - Popa-Wagner, Aurel
AU - Godoy, Daniel A.
N1 - Funding Information:
This project was supported by each participating center's institutional/departmental funds. C.J.M. Klijn is supported by a clinical established investigator grant from the Dutch Heart Foundation ( 2012T077 ), and an ASPASIA grant from The Netherlands Organisation for Health Research and Development , ZonMw (grant number 015008048 ). Adrian Parry-Jones is funded by an NIHR Clinician Scientist Award.
Publisher Copyright:
© 2017 Elsevier Inc. All rights reserved.
PY - 2017/10
Y1 - 2017/10
N2 - Purpose Hypoalbuminemia and systemic inflammatory response syndrome (SIRS) are reported in critically-ill patients, but their relationship is unclear. We sought to determine the association of admission serum albumin and SIRS with outcomes in patients with intracerebral hemorrhage (ICH). Methods We used a multicenter, multinational registry of ICH patients to select patients in whom SIRS parameters and serum albumin levels had been determined on admission. Hypoalbuminemia was defined as the lowest standardized quartile of albumin; SIRS according to standard criteria. Primary outcomes were modified Rankin Scale (mRS) at discharge and in-hospital mortality. Regression models were used to assess for the association of hypoalbuminemia and SIRS with discharge mRS and in-hospital mortality. Results Of 761 ICH patients included in the registry 518 met inclusion criteria; 129 (25%) met SIRS criteria on admission. Hypoalbuminemia was more frequent in patients with SIRS (42% versus 19%; p < 0.001). SIRS was associated with worse outcomes (OR: 4.68, 95%CI, 2.52–8.76) and in-hospital all-cause mortality (OR: 2.18, 95% CI, 1.60–2.97), while hypoalbuminemia was not associated with all-cause mortality. Conclusions In patients with ICH, hypoalbuminemia is strongly associated with SIRS. SIRS, but not hypoalbuminemia, predicts poor outcome at discharge. Recognizing and managing SIRS early may prevent death or disability in ICH patients.
AB - Purpose Hypoalbuminemia and systemic inflammatory response syndrome (SIRS) are reported in critically-ill patients, but their relationship is unclear. We sought to determine the association of admission serum albumin and SIRS with outcomes in patients with intracerebral hemorrhage (ICH). Methods We used a multicenter, multinational registry of ICH patients to select patients in whom SIRS parameters and serum albumin levels had been determined on admission. Hypoalbuminemia was defined as the lowest standardized quartile of albumin; SIRS according to standard criteria. Primary outcomes were modified Rankin Scale (mRS) at discharge and in-hospital mortality. Regression models were used to assess for the association of hypoalbuminemia and SIRS with discharge mRS and in-hospital mortality. Results Of 761 ICH patients included in the registry 518 met inclusion criteria; 129 (25%) met SIRS criteria on admission. Hypoalbuminemia was more frequent in patients with SIRS (42% versus 19%; p < 0.001). SIRS was associated with worse outcomes (OR: 4.68, 95%CI, 2.52–8.76) and in-hospital all-cause mortality (OR: 2.18, 95% CI, 1.60–2.97), while hypoalbuminemia was not associated with all-cause mortality. Conclusions In patients with ICH, hypoalbuminemia is strongly associated with SIRS. SIRS, but not hypoalbuminemia, predicts poor outcome at discharge. Recognizing and managing SIRS early may prevent death or disability in ICH patients.
KW - Albumin
KW - Hypoalbuminemia
KW - Inflammation
KW - Intracerebral hemorrhage
KW - Stroke outcomes
KW - Systemic inflammatory response syndrome
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U2 - 10.1016/j.jcrc.2017.06.002
DO - 10.1016/j.jcrc.2017.06.002
M3 - Article
C2 - 28599198
AN - SCOPUS:85029722140
SN - 0883-9441
VL - 41
SP - 247
EP - 253
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -