Clinical significance of Albumin in Acute Cardioembolic Strokes

Abstract

We conducted our study among fifty consecutive patients admitted to stroke unit in Ain Shams University hospitals with acute ischemic stroke and a picture suggesting a cardioembolic origin according to the CCS (causative classification system for Ischemic stroke) and TOAST classification during the first 48 hours after onset. Exclusion criteria were decompensated liver disease (scoring more than one point at the albumin component of child-Pugh scale), Renal disease (Serum Cr more than 1.5 mg/dl) and Diabetes Mellitus (HBA1C greater than 7). The study subjects were investigated by basic laboratory data including serum Albumin and quantitative CRP, in addition to basic cardiological investigations which included Echocardiography highlighting the ejection fraction, left atrial diameter and the presence or absence of segmental wall motion abnormalities and ECG. The size of the subjects’ stroke was estimated using the ABC/2 method calculated from the MRI diffusion film. The initial burden and the prognosis of our subjects’ ischemic cardioembolic strokes were estimated using the NIHSS and the MRS conducted 3 months after the onset of their insults. Demographic data of patients revealed that the mean of age among the study subjects (n=50) is 61.4 ±11.3 years .It also shows that the mean time since stroke onset is 17.4±7.4. The study subjects were investigated by basic laboratory tests to omit any subject labeled by an exclusion criteria. Mean AST (20.7±5.4) ALT (21.5±6.0) INR(1.0±0.1 ) HBA1C (5.7±0.3) Serum Creatinine (0.8±0.1). The results of the basic cardiological investigations show: subjects with positive SWMA (52%,n=26)Valvular lesion (18% n=9), Normal ECG (16% n=8) AF (56% n=28),Paroxysmal AF (28% n=14 ) the mean ejection fraction was 54.1±11.9(Range =25.0–77.0) and the mean LAD was 47.8±5.5(Range =35.0–75.0). Moreover quantitative CRP, total proteins, and serum Albumin were withdrawn from our study subjects and their results are Albumin (mean=3.6±0.6,range 2.6–5.0) CRP (Mean=3.0 (2.4–4.9), range 0.9–10.5). The mean stroke size dimensions are Vertical (4.0) horizontal (4.0) depth (5.0), size (50.0 mm3) (Range=24.0–111.0). Furthermore the study subjects were assessed using the NIHSS on admission which showed a mean value of 10 and a range of 8-14 MRS at 3 months after the onset of the CE ischemic stroke shows a mean value of 3.0 and a range of 2.0-4.0. Our study shows that: There are significant positive correlations between NIHSS and the following values: CRP (r=0.769,P<0.001) ESR (r=0.388, P=0.005)& stroke dimensions(P<0.001,r=0.612). There are significant negative correlations between NIHSS and albumin (r=-0.679,P<0.001)& ejection fraction. (P<0.001,r=-0.506). The study also shows that there are significant positive correlations between MRS and CRP (r=0.799,P<0.001), ESR (P=0.019,r=0.330) NIHSS(r=0.886,P<0.001) & stroke dimensions. (P<0.001,r=0.621)and there are significant negative correlations between MRS and albumin (P<0.001,r=-0.756) & ejection fraction.(P<0.001,r=-0.447) Moreover significant positive correlations are found between albumin and ejection fraction. (P<0.001,r=0.588) There are significant negative correlations between albumin and CRP,(P<0.001,r=-0.698) ESR (P=0.021,r=-0.325)& stroke size.(P=0.002,r=-0.437)There are significant positive correlations between CRP and stroke dimensions(P<0.001,r=0.538)There are significant negative correlations between CRP and ejection fraction.(P<0.001,r=-0.472) It is also noticed that cases with SWMA have significantly lower albumin (P=0.017) and significantly higher CRP(P=0.011), NIHSS (P=0.026) and MRS(P=0.071) on the other hand ,no significant difference between cases with and without ECG abnormalities as regards to NIHSS, MRS, Albumin and CRP.