• Mario Di Napoli, Réza Behrouz, Christopher H Topel, Vivek Misra, Fulvio Pomero, Alessia Giraudo, Paolo Pennati, Luca Masotti, Schreuder Floris H B M FHBM Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Neurology, Donders Institute for Bra, Julie Staals, Klijn Catharina J M CJM Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Craig J Smith, Adrian R Parry-Jones, Mark A Slevin, Brian Silver, Joshua Z Willey, Mahmoud R Azarpazhooh, Jaime Masjuán Vallejo, Hipólito Nzwalo, Aurel Popa-Wagner, Daniel A Godoy, and MNEMONICH Investigators.
• Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy. Electronic address: mariodinapoli@katamail.com.
• J Crit Care. 2017 Oct 1; 41: 247-253.

PurposeHypoalbuminemia and systemic inflammatory response syndrome (SIRS) are reported in critically-ill patients, but their relationship is unclear. We sought to determine the association of admission serum albumin and SIRS with outcomes in patients with intracerebral hemorrhage (ICH).MethodsWe used a multicenter, multinational registry of ICH patients to select patients in whom SIRS parameters and serum albumin levels had been determined on admission. Hypoalbuminemia was defined as the lowest standardized quartile of albumin; SIRS according to standard criteria. Primary outcomes were modified Rankin Scale (mRS) at discharge and in-hospital mortality. Regression models were used to assess for the association of hypoalbuminemia and SIRS with discharge mRS and in-hospital mortality.ResultsOf 761 ICH patients included in the registry 518 met inclusion criteria; 129 (25%) met SIRS criteria on admission. Hypoalbuminemia was more frequent in patients with SIRS (42% versus 19%; p<0.001). SIRS was associated with worse outcomes (OR: 4.68, 95%CI, 2.52-8.76) and in-hospital all-cause mortality (OR: 2.18, 95% CI, 1.60-2.97), while hypoalbuminemia was not associated with all-cause mortality.ConclusionsIn patients with ICH, hypoalbuminemia is strongly associated with SIRS. SIRS, but not hypoalbuminemia, predicts poor outcome at discharge. Recognizing and managing SIRS early may prevent death or disability in ICH patients.Copyright © 2017 Elsevier Inc. All rights reserved.

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