Admission Serum Albumin as a Predictor of Cardiovascular Complications in Non-Traumatic Intracerebral Hemorrhage.

Background

Early cardiovascular complications after non-traumatic intracerebral hemorrhage (ICH) contribute to short-term morbidity and mortality, yet reliable prognostic markers remain limited. We examined the association between admission serum albumin and 30-day cardiovascular complications after ICH, including dose-response patterns and consistency across subgroups.

Methods

In this retrospective cohort study using the TriNetX US Collaborative Network, adults hospitalized with ICH (ICD-10-CM I61) and serum albumin measured within 24 h of admission were stratified into reduced (≤3.4 g/dL) and normal (≥3.5 g/dL) groups and balanced by 1:1 propensity score matching on demographics, cardiovascular comorbidities, ICH severity, neurosurgical procedures, and medications. The primary outcome was a 30-day composite of all-cause death, acute myocardial infarction, heart failure, atrial fibrillation or flutter, ventricular arrhythmias, and Takotsubo cardiomyopathy. Sensitivity analyses addressed age, sex, comorbidity burden, and chronic hypoalbuminemia.

Results

Of 241,228 patients, 94,925 (39%) had reduced albumin; 79,751 were retained per group after matching. The composite outcome occurred in 40.4% versus 33.3% (HR 1.28, 95% CI 1.26-1.30; p < 0.0001). Reduced albumin was associated with higher all-cause mortality (HR 1.50), myocardial infarction (HR 1.36), heart failure (HR 1.22), ventricular arrhythmias (HR 1.41), and Takotsubo cardiomyopathy (HR 1.41; all p < 0.005). Atrial fibrillation or flutter did not differ (HR 1.02; p = 0.779). A dose-response was observed, with severe hypoalbuminemia conferring greater composite risk (HR 1.49) than mild (HR 1.16). Findings were consistent across all sensitivity analyses.

Conclusions

Reduced admission serum albumin is independently associated with higher short-term mortality and cardiovascular complications after ICH and may aid early risk stratification. Prospective studies are needed to clarify its utility.