| ObjectivesThe objectives of this study are to explore the predictive value of serum albumin in patients with ischemic stroke recurrence and poor outcomes by testing albumin level within 24 hours of admission,to investigate the prevalence of recurrence and poor outcomes about first-ever ischemic stroke within 1 year,and to identify risk factors for recurrence and poor outcomes about first-ever ischemic stroke in acute.MethodsThis cross-sectional study included 753 first-ever ischemic stroke patients during acute phase(the first week following a stroke)with a 1-year follow-up.All patients admitted into the neurological department at a Class-three Hospital in Kaifeng,China,from March 2014 to March 2015 were evaluated for eligibility for the study.Blood samples for assessment of albumin were obtained from all patients within 24 hours of admission after stroke onset,in addition,the survey included general demographic variables,disease-related variables,National Institute of Health stroke scale(NIHSS)at admission.After 1 year in sick patients,the patient's recurrence state,survival state and recovery of function were assessed to determine the association between albumin level on admission and patient's outcomes by follow-up,The poor outcomes include disability and death,the disability was defined as a score of ?2 or ?3 using the Modified Rankin Scale(MRS),the different definitions will be discussed separately.The MRS score of death patients was 6 score.The data was inputted by EpiData 3.1 to establish the database,SPSS 17.0 and SAS 9.2 were applied to analyze the statistical analysis.The basic data were described by frequency,percentage,Means and standard deviations(SD).The t-test,chi-square and Wilcoxon-log rank test were performed to test the difference of variables within groups.The multivariate analysis was performed by using logistic regression analysis.Receiver Operating Characteristic Curve(ROC)was used to estimate the predictive effect of admission serum albumin and conventional factors on recurrence and discharged outcomes among patients with acute ischemic stroke.Two-tailed analyses were conducted with the significance level of 0.05.Results(1)The average age of 753 patients with acute ischemic stroke was 63.72±12.76 years,there were 432 males(57.4%)and 321 females(42.6%).Of these patients,466(61.9%)were old(age?60),most patients(84.9%)were married,410(54.4%)live in cities,286(38.0%)normal weight.The patients with underweight,overweight and obese patients were 16(2.1%),318(42.2%)and 133(17.7%),respectively.The patients with smoking and drinking were 210(27.9%)and 171(22.7%).The patients with hypertension,diabetes,coronary heart disease and hyperlipidemia were 406(53.9%),170(22.6%),97(12.9%),and 481(63.9%).A minority of patients(15.8%)had family history of stroke,186(24.7%)patients were poor neurological function(NIHSS?4).(2)The mean albumin level of all patients was 38.6(range,21.16-47.30)g/L,the standard deviation was 3.47g/L.The average level of albumin in the rural group was significantly lower than that in the urban group(P=0.004).Compared with the normal group,the average level of albumin in overweight and obesity group was significantly higher than that in the normal group(P< 0.001),underweight group was higher than that in the normal group,but there was no significant difference(P=0.787).(3)692 patients(91.9%)completed the 1-year follow-up.Results of follow-up showed that 22(3.2%)patients died,and 97(14%)patients of ischemic stroke reappeared(of whom,14 patients dead from the recurrence of ischemic stroke).272(39.3%)were poor outcomes(MRS?2),146(21.1%)were poor outcomes(MRS?3).(4)The average level of albumin in the recurrence group was significantly lower than no recurrence group(P< 0.001),The mean level of albumin in the poor outcome group was significantly lower than good group(P< 0.001).The patients were divided into 4 groups according to the level of albumin,the incidence rate of recurrence and poor outcomes were higher at the lower group.The incidence rate of recurrence and poor outcomes in patients with hypoproteinemia was significantly higher than that normal albumin levels(P< 0.001)(5)The multivariate Logistic regression analysis revealed that 1g/L serum albumin increased,the risk of recurrence were reduced 14.6%.The patients were divided into four groups according to the quartile of serum albumin,the risk of recurrence with serum albumin in the second,third and the forth quartile were reduced respectively 45.7%,55.1% and 71% with the first group reference,OR and 95%CI were 0.543(0.307-0.959),0.449(0.249-0.812)and(0.148-0.570),respectively.The risk of recurrence among patients with hypoproteinemia was 3.261 times as high as patients with normal albumin levels.At the same time,diabetes,NIHSS scores were the risk factors for recurrence(P<0.05).(6)The multivariate Logistic regression analysis revealed that 1g/L serum albumin increased,the risk of poor outcomes were reduced 4.0%(MRS?2)?17.3%(MRS?3).The risk of poor outcomes with serum albumin in the second,third and the forth quartile were reduced respectively 60.1%?66.1% and 66.4%(MRS?2)?57.9%?65.0% and 68.5%(MRS?3)with the first group reference.The risk of poor outcomes among patients with hypoproteinemia was 4.862(MRS?2)/7.049(MRS?3)times as high as patients with normal albumin levels.At the same time,diabetes,NIHSS scores were the risk factors for poor outcomes(P<0.05).(7)Recurrence or not as the dependent variable,the areas under ROC curve(area under the curve,AUC)for containing serum albumin and conventional factors(AUC=0.687)were larger than conventional factors(AUC=0.613),P<0.001.Poor outcomes or not as the dependent variable,the areas under ROC curve(area under the curve,AUC)for containing serum albumin and conventional factors(AUC=0.696)were larger than conventional factors(AUC=0.654),P<0.001(MRS?2),the areas under ROC curve(area under the curve,AUC)for containing serum albumin and conventional factors(AUC=0.730)were larger than conventional factors(AUC=0.669),P<0.001(MRS?3).Conclusion(1)The higher the level of serum albumin was,the lower the risk of recurrence and poor outcomes in patients with ischemic stroke were.(2)Hypoproteinemia is an independent predictor for recurrence and poor outcomes in patients with ischemic stroke.(3)The predictive effect of containing both serum albumin and conventional factors on recurrence and poor outcomes among patients with acute ischemic stroke was stronger than conventional factors.(4)Diabetes and NIHSS scores were the risk factors for recurrence and poor outcomes in patients with ischemic stroke. |
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