Association of nadir serum albumin during hospitalization with mortality in ICU patients with spontaneous intracerebral hemorrhage.

Authors

Minzhi Zhang, Yang Liu, Zhiying Zhang, Chang Liu, Tao Liu, Chunsheng Yang

Published in

Frontiers in neurology. Volume 17. Pages 1871576. Epub Jul 20, 2026.

Abstract

Hypoalbuminemia is common among critically ill patients and has been associated with adverse clinical outcomes. However, the prognostic significance of the nadir serum albumin level during hospitalization in patients with spontaneous intracerebral hemorrhage (ICH) admitted to the intensive care unit (ICU) remains unclear. This study aimed to investigate the association between in-hospital lowest serum albumin levels and clinical outcomes in ICU patients with spontaneous ICH.
We conducted a retrospective cohort study using pooled data from the Tianjin cohort and Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Adult ICU patients with spontaneous ICH were included. The primary outcome was 28-day all-cause mortality. Multivariable Cox proportional hazards models were used to assess associations between nadir serum albumin during ICU stay and 28-day mortality. Restricted cubic splines (RCS) were applied to examine potential nonlinear relationships.
The incidence of 28-day mortality increased from 17.2% in the >35 g/L group to 39.3% in the < 30 g/L group, while 90-day mortality increased from 21.2% to 52.0% (both P < 0.001). Similarly, ICU mortality and in-hospital mortality increased progressively with decreasing albumin levels. In addition, patients with lower albumin levels had significantly longer ICU and hospital stays (both P < 0.001). RCS analyses showed no clear evidence of nonlinearity in the fully adjusted model. Subgroup analyses by mechanical ventilation (MV) status showed that lower albumin levels were associated with increased mortality among patients without MV, whereas these associations were attenuated among those receiving MV. Significant interaction by MV status was observed for in-hospital, 28-day, and 90-day mortality (all P for interaction < 0.05), but not for ICU mortality.
Lower nadir serum albumin levels during hospitalization are independently associated with increased mortality in ICU patients with spontaneous ICH. The prognostic value of albumin appears to vary by illness severity and treatment intensity, as reflected by MV status. These findings suggest that nadir serum albumin level may be a simple and clinically relevant prognostic marker for risk stratification in this population.

PMID:
42544300
Bibliographic data and abstract were imported from PubMed on 03 Aug 2026.

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