Albumin impact on clinical practice and complications of ischemic stroke in patients with stroke
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20163246Keywords:
Ischemic stroke, Albumin, ArdabilAbstract
Background: Cerebrovascular disease is the third common leading cause of death after cancer and heart disease in the United States. Also cerebrovascular disease is the most common neurological disease which can lead to complications or mortality. The incidence of ischemic stroke increases with age, and almost two thirds of cases occur in people over 65 years. Albumin as a blood thinner to reduce blood viscosity and sufficient vasodilation in response to low oxygen increases blood flow in ischemic and normal brain. The aim of this study was to investigate the Albumin impact on clinical practice and complications of ischemic stroke in patients with stroke.
Methods: This is a randomized clinical study that has been done on 100 patients with ischemic stroke included 54 male and 46 female referred to Alavi hospital in Ardabil. Patients with inclusion criteria randomly divided in two similar sample size groups. For case group we prescribed albumin 20% and for control group normal-saline. NIHSS questionnaire completed for each patient based on their interview and medical documents in hospital according the specialist doctor idea. Collected data analysed by statistical methods in SPSS.19.
Results: From all patients, 41% have HTN, 30% Diabetes, 32% ischemic stroke type cortical in branch MCA and 14% in brain stem. The highest risk factor for stroke was in people with high blood pressure. The mean of NIHSS in the end of third month after intervention in the patients with cortical ischemia in albumin group with 24.8±5.1 was lower than placebo group with 31.3±3 and this difference was statistically significant (p = 0.012).
Conclusions: Results showed that in cortical ischemic stroke there was a significant relationship between receiving albumin and decreasing NISHH score. But there was no significant relationship between receiving albumin and decreasing NISHH score in Lacunar and brain stem stroke.
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References
Scherbakov N, Doehner W. Sarcopenia in stroke-facts and numbers on muscle loss accounting for disability after stroke. J Cachexia Sarcopenia Muscle. 2011;2(1):5-8.
Green AR. Pharmacological approaches to acute ischaemic stroke: reperfusion certainly, neuroprotection possibly. Br J Pharmacol. 2008;153(Suppl 1):S325-338.
Woodruff TM, Thundyil J, Tang SC, Sobey CG, Taylor SM, Arumugam TV. Pathophysiology, treatment, and animal and cellular models of human ischemic stroke. Mol Neurodegener. 2011;6:11.
Mitchell RS, Kumar V, Abbas AK, Fausto N. Robbins Basic Pathology, 8th edn. Philadelphia, PA: Saunders; 2007.
Remmers M, Schmidt-Kastner R, Belayev L, Lin B, Busto R, Ginsberg MD. Protein extravasation and cellular uptake after high-dose human-albumin treatment of transient focal cerebral ischemia in rats. Brain Research. 1999;827(1-2):237-42.
Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: a major contributor to stroke in the elderly: the Framingham study. Arch Intern Med. 1987;147(9):1561-4.
Nadal A, Fuentes E, Pastor J, McNaughton PA. Plasma albumin is a potent trigger of calcium signals and DNA synthesis in astrocytes. Proc Natl Acad Sci USA. 1995;92(5):1426-30.
Tabernero A, Medina A, Sánchez-Abarca LI, Lavado E, Medina JM. The effect of albumin on astrocyte energy metabolism is not brought about through the control of cytosolic Ca2+ concentrations but by free-fatty acid sequestration. Glia. 1999;25(1):1-9.
Belayev L, Zhao W, Pattany PM, Weaver RG, Huh PW, Lin B, et al. Diffusion-weighted magnetic resonance imaging confirms marked neuroprotective efficacy of albumin therapy in focal cerebral ischemia. Stroke. 1998;29:2587-99.
Dziedzic T, Slowik A, Szczudlik A. Serum albumin level as a predictor of ischemic stroke outcome. Stroke. 2004;35(6):e156-158.
Famakin B, Weiss P, Hertzberg V, McClellan W, Presley R, Krompf K, et al. Hypoalbuminemia predicts acute stroke mortality: paul coverdell georgia stroke registry. Journal of Stroke and Cerebrovascular Diseases. 2010;19(1):17-22.
Babu MS, Kaul S, Dadheech S, Rajeshwar K, Jyothy A, Munshi A. Serum albumin levels in ischemic stroke and its subtypes: correlation with clinical outcome. Nutrition. 2013;29(6):872-5.
Chakraborty B, Vishnoi G, Goswami B, Gowda SH, Chowdhury D, Agarwal S. Lipoprotein(a), ferritin, and albumin in acute phase reaction predicts severity and mortality of acute ischemic stroke in North Indian Patients. Journal of Stroke and Cerebrovascular Diseases. 2013;22(7):e159-167.
Palesch YY, Hill MD, Ryckborst KJ, Tamariz D, Ginsberg MD. The ALIAS pilot trial: a dose-escalation and safety study of albumin therapy for acute ischemic stroke-II: neurologic outcome and efficacy analysis. Stroke. 2006;37:2107-14.
Belayev L, Lio Y, Zhao W, Busto R, Ginsberg MD. Human albumin therapy of acute ischemic stroke marked neuroprotective efficacy at moderate doses and with a broad therapeutic window. Stroke. 2001;32:553-60.
Tang J, Mu J, Li Q, Yang DY, Xie P. Albumin ameliorates tissue plasminogen activator-mediated blood-brain barrier permeability and ischemic injury in rats. Neurol Res. 2009;31(2):189-94.
Schnitzer J. Antibodies to SPARC inhibit albumin binding to SPARC, gp60, and microvascular endothelium. American journal of physiology. 1992;263(6 Pt 2):H1872-1879.
Reinhart WH, Nagy C. Albumin affects erythrocyte aggregation and sedimentation. European Journal of Clinical Investigation. 1995;25(7):523-8.
Zoellner H, Beckmann R, Beckmann R, Hufnagl P, Vanyek E, Bielek E, et al. Serum albumin is a specific inhibitor of apoptosis in human endothelial cells. J Cell Sci. 1996;109(Pt 10):2571-80.
Dziedzic T, Slowik A, Gryz-Kurek EA, Szczudlik A. Hypoalbuminemia in acute ischemic stroke patients: frequency and correlates. European Journal of Clinical Nutrition. 2007;61:1318-22.