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Association Between Serum Albumin and Hospital-Acquired Infections After Aneurysmal Subarachnoid Hemorrhage

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Abstract

Background

Low serum albumin levels have been identified as a predictor of infectious complications in critically ill patients. However, the association in patients with aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. We aimed to evaluate the prognostic value of hypoalbuminemia using blood samples at admission in patients with aSAH.

Methods

In a multicenter observational study of patients with aSAH, serum albumin counts were collected on admission. Hypoalbuminemia was defined as a total albumin level < 35 g/L. Multivariable logistic regression analyses and propensity score matching were performed to obtain the adjusted odds ratios (ORs) with 95% confidence intervals (CI) for the primary outcome of hospital-acquired infections.

Results

A total of 5448 patients were included in the observational cohort study. The odds of hospital-acquired infections were significantly higher in patients with albumin levels 30–34.9 g/L (OR 1.62, 95% CI 1.38–1.90), 25–29.9 g/L (OR 1.97, 95% CI 1.54–2.51), and < 24.9 g/L (OR 2.43, 95% CI 1.53–3.86) compared with patients with albumin level ≥ 35 g/L. The odds of hospital-acquired infections with a change in albumin levels from admission to 48–72 h later of lower than − 10 g/L and − 10 to − 5 g/L were 1.67 (95% CI 1.41–1.86) and 1.24 (95% CI 1.05–1.46), respectively, compared with a change in albumin levels of − 5 to 5 g/L.

Conclusions

In this large study of matched patients with aSAH, hypoalbuminemia at admission was associated with hospital-acquired infections. A decrease in serum albumin levels within 72 h of admission was associated with higher hospital-acquired infections.

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Funding

Funded by the project of Health Commission of Sichuan Province (19PJ003) (Yu Zhang), the project of Sichuan Science and Technology Bureau (2020YFS0490) (Yu Zhang), and the 1·3·5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (21HXFH046) (Fang Fang).

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Authors and Affiliations

  1. Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Peng Wang, Yu Zhang, Xing Wang, Chao You & Fang Fang

  2. Department of Neurosurgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China

    Peng Wang, Yu Zhang & Liyuan Peng

  3. Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China

    Lu Jia

  4. Department of Neurosurgery, West China Longquan Hospital, Sichuan University, Chengdu, Sichuan, China

    Tiangui Li

  5. Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

    Weelic Chong

  6. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Yang Hai

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  1. Peng Wang
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  2. Yu Zhang
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  3. Xing Wang
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  9. Chao You
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  10. Fang Fang
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Contributions

Study concept and design: FF. Acquisition, analysis, or interpretation of data: PW, YZ, LP, TL, YH, and LJ. Statistical analysis: PW and XW. Drafting of the manuscript: PW and YZ. Critical revision of the manuscript for important intellectual content: all authors. The final manuscript was approved by all authors.

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Correspondence to Fang Fang.

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All authors declare that we have no conflicts of interest.

Ethical approval/informed consent

The ethics committee of West China Hospital (No. 20191133), the ethics committee of West China Longquan Hospital Sichuan University (No. AF-LZ-2020001), the ethics committee of Affiliated Hospital of Chengdu University (No. PJ2021-018–03), and the ethics committee of Shanxi Provincial People’s Hospital (No. 202110) approved this study.

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Wang, P., Zhang, Y., Wang, X. et al. Association Between Serum Albumin and Hospital-Acquired Infections After Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 37, 424–434 (2022). https://doi.org/10.1007/s12028-021-01421-y

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  • DOI: https://doi.org/10.1007/s12028-021-01421-y

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