PLASMA ALBUMIN LEVELS AND OUTCOME OF STROKE IN ADULT PATIENTS ADMITTED TO THE UNIVERSITY TEACHING HOSPITAL, LUSAKA
Abstract

Author(s): Kampolo Dominic, Soka Nyirenda, Fastone Goma, Peter Simoonga.

Albumin is a potent neuroprotective protein capable of influencing the disease process in Stroke. However, this neuromodulation has not been well documented in black African patients. This study was aimed at determining the association between plasma Albumin levels and outcome of Stroke in adult patients and the possible use of plasma Albumin level as a prognostic indicator in Stroke. Methods: Sequential first episode acute Hemorrhagic and Ischemic Stroke patients were enrolled into the study between December 2016 and May 2017. Neurological examinations were based on the National Institute of Health Stroke Scale (NIHSS). Admission plasma Albumin levels were measured using electrophoresis and CT scan imaging done. All parameters were assessed on day 0, 3, 5, and discharge from hospital and on follow-up for 2 weeks (total duration of 6 weeks). The outcome measures were 6 weeks mortality and functional outcome which were scored using the modified Rankin scale (mRS) and modified Asthworth score. Results: A total of 50 acute Stroke participants were studied. The mean age was 54.30 ±14.25 years. Ischemic Stroke accounted for 62% of participants whereas 38% had Hemorrhagic Stroke. While 38% of Hemorrhagic Stroke participants died between day 3 and 13 (mean 7.34±3.86 days) of Stroke occurrence, only 9.7% of Ischemic participants died during the same period. The 6 weeks mortality rate was 16% in participants with hypoalbinemia compared to 2% in participants with normal Albumin. Albumin levels in the range of 20 to 30mg/ml (OR, 2.67; 95% confidence interval, 1 to 10) and a drop of more than 10mg/ml from admission to outcome was noted in those who died. Albumin Decrease Index (ADI) of 0.942, mean NIHSS of 8.76±4.25 and mRS 3.28±1.43 (p=0.0001) were associated with poor outcome. Conclusion: Albumin was significantly low with a high ADI in Stroke participants with a poor outcome. Patients with hypoalbuminemia are more than twice at risk of having a poor outcome. There was no difference in the ADI between Hemorrhagic and Ischemic stroke suggesting that Albumin is a good predictor of outcome in both types of Stroke.

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