Original Article
Hypoalbuminemia Predicts Acute Stroke Mortality: Paul Coverdell Georgia Stroke Registry

https://doi.org/10.1016/j.jstrokecerebrovasdis.2009.01.015Get rights and content

Background

Mortality remains unacceptably high among patients hospitalized for acute stroke. Additional knowledge about factors that contribute to mortality after stroke is important for instituting therapies to lower mortality. We sought to determine the factors that predict mortality in patients hospitalized for acute stroke.

Methods

In all, 1477 consecutively admitted patients with acute stroke in 34 hospitals in the state of Georgia participating in the Paul Coverdell Georgia Stroke Registry during a 3-month period (December 1, 2001-February 28, 2002) were identified by retrospective chart review using primary or secondary International Classification of Diseases, Ninth Revision codes. Of patients, 31% were black, 65% were white, and 58% were women. We determined inhospital mortality after admission for acute stroke in this representative group of patients.

Results

There were 154 (10%) inhospital deaths among the 1477 patients admitted with acute stroke. Univariate analysis showed that mortality was associated with older age (P = .0008), stroke type (P = .0051), Glasgow Coma Scale score less than 9 (P < .0001), decreased serum albumin (P = .0001), elevated creatinine (P = .0067), and elevated blood glucose (P = .0063). In the multivariate analysis, independent risk factors for mortality after acute stroke included older age (P = .004), stroke type (P = .0007), Glasgow Coma Scale score less than 9 (P < .0001), and decreased serum albumin (P = .0003). There was no relationship between race and inhospital mortality (P = .9041). In addition, there was no association between independent predictors and race.

Conclusion

In addition to previously recognized predictors of inhospital mortality, we found hypoalbuminemia to be an independent predictor of mortality in a biracial cohort of patients with acute stroke.

Section snippets

Hospital Selection

The Paul Coverdell Georgia Stroke Registry (PCGSR) was one of 4 sites initially funded by the Centers for Disease Control and Prevention in 2001 to design and implement a registry prototype. Hospital selection was intended to create a representative sample from the state. In Georgia, approximately one third of the hospitals were randomly selected using a simple random sampling procedure.18 The 8 largest hospitals in the state, in terms of stroke volume, were selected with certainty. Of the

Results

There were 1477 consecutively admitted patients identified with an acute cerebrovascular event meeting entry criteria from the 34 hospitals participating in the PCGSR across the state of Georgia (Fig 1). Frequency of stroke types were as follows: acute ischemic stroke (63%), transient ischemic attack (19%), ICH (9%), and SAH (3%). Of cases, 6% were classified as hemorrhages or strokes of undetermined type.

Discussion

This analysis evaluated factors predicting inhospital mortality in a biracial cohort of patients admitted to a representative sample of hospitals in the state of Georgia, a region of the United States that is disproportionately affected by stroke.20

In this group of patients, decreased serum albumin was an independent predictor of mortality in patients admitted for acute stroke. Older age and stroke type (ischemic v hemorrhagic) were also independent predictors of mortality in the multivariate

Conclusions

We report for the first time hypoalbuminemia as an independent predictor of mortality during hospitalization for acute stroke in a representative cohort of patients from a state located in the middle of the stroke belt. We propose that routine serum albumin measurement for determination of hypoalbuminemia be included in factors used early in hospitalization to stratify patients at high risk for inhospital mortality after acute stroke. Additional studies should be taken to determine whether

References (41)

  • L.A. Gillum et al.

    Characteristics of academic medical centers and ischemic stroke outcomes

    Stroke

    (2001)
  • N.M. Bornstein et al.

    The Tel Aviv stroke registry: 3600 consecutive patients

    Stroke

    (1996)
  • R. Bonita et al.

    Predicting survival after stroke: A three-year follow-up

    Stroke

    (1988)
  • B.R. Chambers et al.

    Prognosis of acute stroke

    Neurology

    (1987)
  • B.L. Cucchiara et al.

    Early impairment in consciousness predicts mortality after hemispheric ischemic stroke

    Crit Care Med

    (2004)
  • M.R. Frankel et al.

    Predicting prognosis after stroke: A placebo group analysis from the National Institute of Neurological Disorders and Stroke rt-pa stroke trial

    Neurology

    (2000)
  • B.B. Hamidon et al.

    The impact of diabetes mellitus on in-hospital stroke mortality

    J Postgrad Med

    (2003)
  • E. Woo et al.

    Admission glucose level in relation to mortality and morbidity outcome in 252 stroke patients

    Stroke

    (1988)
  • S.E. Capes et al.

    Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: A systematic overview

    Stroke

    (2001)
  • P.U. Heuschmann et al.

    Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: The German stroke registers study group

    Arch Intern Med

    (2004)
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    The Paul Coverdell Georgia Stroke Registry Pilot Prototype is supported by Centers for Disease Control and Prevention Cooperative Agreement No. U50/CCU420275-01. Principal Investigator: Michael R. Frankel.

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