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Albumin-Induced Neuroprotection in Focal Cerebral Ischemia in the ALIAS Trial: Does Severity, Mechanism, and Time of Infusion Matter?

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Abstract

Objective

To determine whether there is any differential benefit of albumin administration within 2 h of onset of ischemia and in settings (severe ischemia with reperfusion in cardioembolic strokes with National Institutes of Health Stroke Scale [NIHSS] ≥15), most representative of experimental models of cerebral ischemia in which albumin was effective in reducing neurological injury.

Background

High-dose intravenous (IV) albumin treatment for acute ischemic stroke (ALIAS) trial did not show overall clinical benefit in ischemic stroke patients in contrast to preclinical studies; however, models of preclinical studies were not completely followed.

Methods

A total of 1275 patients combined from ALIAS trials I and II were included in our analysis. We analyzed preclinical studies and selected patients with large ischemic stroke (NIHSS ≥15) related to cardioembolic etiology (n = 189). Outcomes were then studied including time from onset to IV albumin administration.

Results

The odds of excellent outcome (mRS 0–1) at 3 months was not different with high-dose IV albumin infusion (n = 100) compared with placebo (n = 89) ((odds ratio [OR]) 1.632 [0.719–3.708], p value 0.2419). When we further classified these subjects according to time of IV albumin administration, we observed significantly higher odds of excellent outcome at 3 months when patients received IV albumin within 2 h, OR 9.369 (CI 1.040–84.405), p value 0.0461, after adjusting for age, gender, baseline NIHSS score, and any therapeutic procedure.

Conclusion

A trend for benefit is noted in ischemic stroke patients with large cardioembolic stroke (NIHSS ≥15) when high-dose albumin was initiated within 2 h, suggesting that certain ischemic stroke subgroups of patients most representative of preclinical settings may benefit from such a treatment. Additional clinical trials maybe needed to stratify subjects and treatment assignments according to NIHSS severity and timely randomization to evaluate this concept further.

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Authors and Affiliations

  1. Texas Tech University Health Science Center, El Paso, TX, USA

    Rakesh Khatri, Mohammad Rauf Afzal, Gustavo J. Rodriguez, Alberto Maud, Muhammad Shah Miran, Mohtashim Arbaab Qureshi & Salvador Cruz-Flores

  2. Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA

    Mohammad Rauf Afzal, Muhammad Shah Miran, Mohtashim Arbaab Qureshi & Adnan I. Qureshi

Authors
  1. Rakesh Khatri
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  2. Mohammad Rauf Afzal
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  3. Gustavo J. Rodriguez
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  4. Alberto Maud
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  5. Muhammad Shah Miran
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  6. Mohtashim Arbaab Qureshi
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  7. Salvador Cruz-Flores
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  8. Adnan I. Qureshi
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Correspondence to Rakesh Khatri.

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This article does not contain any studies with animals/human participants performed by any of the authors.

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Khatri, R., Afzal, M.R., Rodriguez, G.J. et al. Albumin-Induced Neuroprotection in Focal Cerebral Ischemia in the ALIAS Trial: Does Severity, Mechanism, and Time of Infusion Matter?. Neurocrit Care 28, 60–64 (2018). https://doi.org/10.1007/s12028-017-0400-0

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  • DOI: https://doi.org/10.1007/s12028-017-0400-0

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