Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage

Mario Di Napoli*, Reza Behrouz, Christopher H. Topel, Vivek Misra, Fulvio Pomero, Alessia Giraudo, Paolo Pennati, Luca Masotti, Floris H. B. M. Schreuder, Julie Staals, Catharina J. M. Klijn, Craig J. Smith, Adrian R. Parry-Jones, Mark A. Slevin, Brian Silver, Joshua Z. Willey, Mahmoud R. Azarpazhooh, Jaime Masjuan Vallejo, Hipolito Nzwalo, Aurel Popa-WagnerDaniel A. Godoy, MNEMONICH Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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. (C) 2017 Elsevier Inc. All rights reserved.

Original languageEnglish
Pages (from-to)247-253
Number of pages7
JournalJournal of Critical Care
Publication statusPublished - Oct 2017


  • Intracerebral hemorrhage
  • Albumin
  • Hypoalbuminemia
  • Inflammation
  • Systemic inflammatory response syndrome
  • Stroke outcomes

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