PDF(Pubmed)
Abstract：
Hypoalbuminemia associates with poor acute ischemic stroke (AIS) outcomes. We hypothesised a non-linear relationship and aimed to systematically assess this association using prospective stroke data from the Norfolk and Norwich Stroke and TIA Register. Consecutive AIS patients aged ≥40 years admitted December 2003-December 2016 were included. Outcomes: In-hospital mortality, poor discharge, functional outcome (modified Rankin score 3-6), prolonged length of stay (PLoS) > 4 days, and long-term mortality. Restricted cubic spline regressions investigated the albumin-outcome relationship. We updated a systematic review (PubMed, Scopus, and Embase databases, January 2020-June 2023) and undertook a meta-analysis. A total of 9979 patients were included; mean age (standard deviation) = 78.3 (11.2) years; mean serum albumin 36.69 g/L (5.38). Compared to the cohort median, albumin < 37 g/L associated with up to two-fold higher long-term mortality (HRmax; 95% CI = 2.01; 1.61-2.49) and in-hospital mortality (RRmax; 95% CI = 1.48; 1.21-1.80). Albumin > 44 g/L associated with up to 12% higher long-term mortality (HRmax1.12; 1.06-1.19). Nine studies met our inclusion criteria totalling 23,597 patients. Low albumin associated with increased risk of long-term mortality (two studies; relative risk 1.57 (95% CI 1.11-2.22; I2 = 81.28)), as did low-normal albumin (RR 1.10 (95% CI 1.01-1.20; I2 = 0.00)). Strong evidence indicates increased long-term mortality in AIS patients with low or low-normal albumin on admission.
摘要：
低白蛋白血症与急性缺血性卒中(AIS)预后不良相关我们假设了非线性关系，并旨在使用来自Norfolk和NorwichStroke和TIARegister的前瞻性卒中数据系统地评估这种关联。纳入2003年12月至2016年12月收治的年龄≥40岁的连续AIS患者。结果：住院死亡率，放电不良,功能结局（改良Rankin评分3-6），延长住院时间(PLoS)>4天，和长期死亡率。限制性三次样条回归研究了白蛋白与结果的关系。我们更新了系统评价(PubMed，Scopus,和Embase数据库，2020年1月-2023年6月），并进行了荟萃分析。共纳入9979例患者；平均年龄（标准差）=78.3（11.2）岁；平均血清白蛋白36.69g/L（5.38）。与队列中位数相比，白蛋白<37g/L与长期死亡率(HRmax;95%CI=2.01;1.61-2.49)和住院死亡率(RRmax;95%CI=1.48;1.21-1.80)高2倍相关。白蛋白>44g/L与高达12%的长期死亡率相关(HRmax1.12;1.06-1.19)。9项研究符合我们的纳入标准，共有23,597名患者。低白蛋白与长期死亡率风险增加相关(两项研究;相对风险1.57(95%CI1.11-2.22;I2=81.28)),正常白蛋白低（RR1.10（95%CI1.01-1.20；I2=0.00））。强有力的证据表明，入院时白蛋白低或正常低的AIS患者的长期死亡率增加。
