Zhu Yuan, Xue Gang, Xu Shufan, Qin Qi, Liu Peian, Ji Lianhong, Wu Huimin, Wu Minghua, Fang Zhuyuan
Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
Department of Medicine, Physiology and Biophysics, UC Irvine Diabetes Center, University of California Irvine (UCI), California, Irvine, USA.
Neurol Ther. 2025 Jun;14(3):949-964. doi: 10.1007/s40120-025-00729-7. Epub 2025 Apr 16.
Several studies indicate that individuals with acute ischemic stroke (AIS) who have low levels of serum albumin (SA) have a dismal prognosis. However, intravenously administering albumin 25% at a dose of 2 g/kg did not lead to improved outcomes for patients with AIS after 90 days. Our objective was to examine the possible correlation between SA levels and stroke outcomes in a prospective cohort investigation.
The research included a total of 5111 participants diagnosed with AIS. The correlation between SA level and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. The relationships were examined employing restricted cubic splines. An investigation was conducted to ascertain the connection between SA levels and neurological functional results by employing mediation analysis, with the mediation impact of low-density lipoprotein (LDL) taken into account. In addition, the subgroup analyses were performed using the logistic regression.
The connection between levels of SA and neurological functional outcomes following AIS exhibited a U-shaped pattern. The likelihood of a negative result dropped significantly with an elevation in SA (per g/L: OR (odds ratio) 0.88; 95% CI (confidence interval) 0.847-0.913) among individuals with SA levels below 42.2 g/L. Conversely, the likelihood of a negative outcome rose with an increase in SA (per g/L: OR 1.033, 95% CI 1.009-1.058) among people with SA levels of 42.2 g/L or above. Comparable findings were seen for mortality outcomes. A mediation study revealed that LDL had a mediating function in the statistical connection between SA levels and neurological functional outcomes, accounting for 12.3% of the connection. No significant interactions were seen in any of the groupings.
Among patients with AIS, there was a U-shaped relationship between SA levels at admission and the likelihood of poor outcomes, which was partially mediated by LDL. There is a Graphical Abstract available for this article.
多项研究表明，血清白蛋白（SA）水平较低的急性缺血性卒中（AIS）患者预后不佳。然而，以2 g/kg的剂量静脉注射25%白蛋白并未使AIS患者在90天后的预后得到改善。我们的目标是在前瞻性队列研究中检验SA水平与卒中预后之间的可能相关性。
该研究共纳入5111名被诊断为AIS的参与者。通过单变量和多变量逻辑分析检验SA水平与发病90天后改良Rankin量表（mRS）评分之间的相关性。采用受限立方样条检验这些关系。通过中介分析，考虑低密度脂蛋白（LDL）的中介作用，对SA水平与神经功能结果之间的联系进行调查。此外，使用逻辑回归进行亚组分析。
AIS后SA水平与神经功能结果之间的关系呈U形模式。在SA水平低于42.2 g/L的个体中，随着SA升高（每克/升：比值比（OR）0.88；95%置信区间（CI）0.847 - 0.913），不良结果的可能性显著降低。相反，在SA水平为42.2 g/L或更高的人群中，随着SA升高（每克/升：OR 1.033，95% CI 1.009 - 1.058），不良结果的可能性增加。死亡率结果也有类似发现。中介研究表明，LDL在SA水平与神经功能结果的统计联系中起中介作用，占该联系的12.3%。在任何分组中均未观察到显著的相互作用。
在AIS患者中，入院时SA水平与不良结果的可能性之间存在U形关系，这部分由LDL介导。本文有一个图形摘要。
