Mario Di Napoli1, Réza Behrouz2, Christopher H Topel2, Vivek Misra3, Fulvio Pomero4, Alessia Giraudo4, Paolo Pennati5, Luca Masotti6, Floris H B M Schreuder7, Julie Staals8, Catharina J M Klijn9, Craig J Smith10, Adrian R Parry-Jones9, Mark A Slevin11, Brian Silver12, Joshua Z Willey13, Mahmoud R Azarpazhooh14, Jaime Masjuán Vallejo15, Hipólito Nzwalo16, Aurel Popa-Wagner17, Daniel A Godoy18. 1. Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy. Electronic address: mariodinapoli@katamail.com. 2. Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA. 3. Houston Methodist Hospital, Houston, TX, USA. 4. Department of Internal Medicine, Ospedale Santa Croce e Carle, Cuneo, Italy. 5. Department of Internal Medicine, Ospedale Santa Croce e Carle, Cuneo, Italy; Emergency-Urgency Department, Ospedale Livorno, Livorno, Italy. 6. Department of Internal Medicine, Ospedale Santa Maria Nuova, Florence, Italy. 7. Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 8. Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands. 9. Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 10. Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, UK; Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK. 11. School of Healthcare Science, Manchester Metropolitan University, Manchester, UK. 12. Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA. 13. Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA. 14. Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. 15. Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. 16. Stroke Unit, Centro Hospitalar do Algarve, University do Algarve, Algarve, Portugal. 17. University of Medicine and Pharmacy Craiova, Romania; Department of Psychiatry, Universitätsmedizin Rostock, Rostock, Germany. 18. Neurocritical Care Unit, Sanatorio Pasteur, Catamarca, Argentina; Unidad de Terapia Intensiva, Hospital Interzonal de Agudos "San Juan Bautista", Catamarca, Argentina.
Abstract
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.
PURPOSE:Hypoalbuminemia and systemic inflammatory response syndrome (SIRS) are reported in critically-illpatients, 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 ICHpatients 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 ICHpatients 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 ICHpatients.
Authors: Manuel Hagen; Jochen A Sembill; Maximilian I Sprügel; Stefan T Gerner; Dominik Madžar; Hannes Lücking; Philip Hölter; Stefan Schwab; Hagen B Huttner; Joji B Kuramatsu Journal: Neurol Neuroimmunol Neuroinflamm Date: 2019-07-01
Authors: Neal S Parikh; Hooman Kamel; Babak B Navi; Costantino Iadecola; Alexander E Merkler; Arun Jesudian; Jesse Dawson; Guido J Falcone; Kevin N Sheth; David J Roh; Mitchell S V Elkind; Daniel F Hanley; Wendy C Ziai; Santosh B Murthy Journal: Stroke Date: 2020-01-07 Impact factor: 7.914