Original Article   

Journal of Neurosurgical Sciences 2022 Jun 28

DOI: 10.23736/S0390-5616.22.05604-1

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Low serum albumin as a risk factor for delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage: eICU collaborative research database analysis

Alis J. DICPINIGAITIS ¹, Vincent P. GALEA ², Tolga SURSAL ², Hussein AL-SHAMMARI ³, Eric FELDSTEIN ², Syed ALI ³, Serena WONG ², Christian BOWERS ⁴, Christian BECKER ⁵, Jared PISAPIA ², Carrie MUH ², Simon HANFT ², Rachana TYAGI ², Stephan A. MAYER ¹, Chirag D. GANDHI ², Fawaz AL-MUFTI ³ ✉

¹ School of Medicine, New York Medical College, Valhalla, NY, USA; ² Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA; ³ Department of Neurology, Westchester Medical Center, Valhalla, NY, USA; ⁴ Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA; ⁵ Department of Medicine, Westchester Medical Center, Valhalla, NY, USA

BACKGROUND: Delayed cerebral ischemia (DCI) represents a devastating complication of aneurysmal subarachnoid hemorrhage (aSAH) and is a significant predictor of morbidity and mortality. Recent studies have implicated inflammatory processes in the
pathogenesis of DCI.
METHODS: aSAH patient data were retrospectively obtained from the eICU Collaborative Research Database (eICU CRD). Multivariable logistic regression models and receiver operating characteristic (ROC) curve analyses were employed to assess the association between low serum albumin (< 3.4 g/dL) and clinical endpoints: DCI and in-hospital mortality.
RESULTS: Among 276 aSAH patients included in the analysis, 35.5% (n=98) presented with low serum albumin levels and demonstrated a higher incidence of DCI (18.4% vs. 8.4%, OR=2.45, 95% CI 1.17, 5.10; p=0.017) and in-hospital mortality (27.6% vs. 16.3%, OR=1.95, 95% CI 1.08, 3.54; p=0.027) compared to patients with normal admission albumin values. In a multivariable model controlling for age and World Federation of Neurosurgical Societies grade, low serum albumin remained significantly associated with DCI (OR=2.52, 95% CI 1.18, 5.36; p=0.017), but not with in-hospital mortality. A combined model for prediction of DCI, encompassing known risk factors in addition to low serum albumin, achieved an area under the curve of 0.65 (sensitivity=0.55, specificity=0.75).
CONCLUSIONS: Serum albumin, a routine and inexpensive laboratory measurement, can may potentially aid in the identification of patients with aSAH at risk for the development of DCI.

KEY WORDS: Albumin; Subarachnoid hemorrhage; Delayed cerebral ischemia; Database; eICU