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-Wagner; Daniel A. Godoy; MNEMONICH Investigators

doi:10.1016/j.jcrc.2017.06.002

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 journal › Article › Academic › peer-review

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

Original language	English
Pages (from-to)	247-253
Number of pages	7
Journal	Journal of Critical Care
Volume	41
DOIs	https://doi.org/10.1016/j.jcrc.2017.06.002
Publication status	Published - Oct 2017

Keywords

Intracerebral hemorrhage
Albumin
Hypoalbuminemia
Inflammation
Systemic inflammatory response syndrome
Stroke outcomes
ISCHEMIC-STROKE PATIENTS
CRITICALLY-ILL PATIENTS
SERUM-ALBUMIN
CONTROLLED-TRIALS
MANAGEMENT
METAANALYSIS
GUIDELINES
RATIONALE
ADMISSION
HEMATOMA

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10.1016/j.jcrc.2017.06.002

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Di Napoli, M., Behrouz, R., Topel, C. H., Misra, V., Pomero, F., Giraudo, A., Pennati, P., Masotti, L., Schreuder, F. H. B. M., Staals, J., Klijn, C. J. M., Smith, C. J., Parry-Jones, A. R., Slevin, M. A., Silver, B., Willey, J. Z., Azarpazhooh, M. R., Vallejo, J. M., Nzwalo, H., ... MNEMONICH Investigators (2017). Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage. Journal of Critical Care, 41, 247-253. https://doi.org/10.1016/j.jcrc.2017.06.002

@article{366c755a7c434c148e5dc2d287544faf,

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

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

keywords = "Intracerebral hemorrhage, Albumin, Hypoalbuminemia, Inflammation, Systemic inflammatory response syndrome, Stroke outcomes, ISCHEMIC-STROKE PATIENTS, CRITICALLY-ILL PATIENTS, SERUM-ALBUMIN, CONTROLLED-TRIALS, MANAGEMENT, METAANALYSIS, GUIDELINES, RATIONALE, ADMISSION, HEMATOMA",

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

year = "2017",

month = oct,

doi = "10.1016/j.jcrc.2017.06.002",

language = "English",

volume = "41",

pages = "247--253",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "W B Saunders Co-Elsevier Inc",

}

Di Napoli, M, Behrouz, R, Topel, CH, Misra, V, Pomero, F, Giraudo, A, Pennati, P, Masotti, L, Schreuder, FHBM, Staals, J, Klijn, CJM, Smith, CJ, Parry-Jones, AR, Slevin, MA, Silver, B, Willey, JZ, Azarpazhooh, MR, Vallejo, JM, Nzwalo, H, Popa-Wagner, A, Godoy, DA & MNEMONICH Investigators 2017, 'Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage', Journal of Critical Care, vol. 41, pp. 247-253. https://doi.org/10.1016/j.jcrc.2017.06.002

TY - JOUR

T1 - Hypoalbuminemia, systemic inflammatory response syndrome, and functional outcome in intracerebral hemorrhage

AU - Di Napoli, Mario

AU - Behrouz, Reza

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 - Willey, Joshua Z.

AU - Azarpazhooh, Mahmoud R.

AU - Vallejo, Jaime Masjuan

AU - Nzwalo, Hipolito

AU - Popa-Wagner, Aurel

AU - Godoy, Daniel A.

AU - MNEMONICH Investigators

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

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

KW - Intracerebral hemorrhage

KW - Albumin

KW - Hypoalbuminemia

KW - Inflammation

KW - Systemic inflammatory response syndrome

KW - Stroke outcomes

KW - ISCHEMIC-STROKE PATIENTS

KW - CRITICALLY-ILL PATIENTS

KW - SERUM-ALBUMIN

KW - CONTROLLED-TRIALS

KW - MANAGEMENT

KW - METAANALYSIS

KW - GUIDELINES

KW - RATIONALE

KW - ADMISSION

KW - HEMATOMA

U2 - 10.1016/j.jcrc.2017.06.002

DO - 10.1016/j.jcrc.2017.06.002

M3 - Article

C2 - 28599198

SN - 0883-9441

VL - 41

SP - 247

EP - 253

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -