What is the clinical evidence from this study?

Study design: Cohort. Population: Non-traumatic intracerebral hemorrhage (n=241228). Intervention: Reduced admission serum albumin (≤3.4 g/dL) vs. Normal admission serum albumin (≥3.5 g/dL). Primary outcome: 30-day composite of all-cause death, acute myocardial infarction, heart failure, atrial fibrillation or flutter, ventricular arrhythmias, and Takotsubo cardiomyopathy (HR 1.28, 95% CI 1.26-1.30, p=<0.0001).

September 5, 2026Journal of Clinical MedicineOpen Access

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

Q: What are the key findings of this study?

Reduced admission serum albumin (≤3.4 g/dL) was associated with a 28% higher hazard of a 30-day composite of death and cardiovascular complications compared to normal albumin in patients with intracerebral hemorrhage.

Q: What does this research mean for the field?

Reduced admission serum albumin is independently associated with a higher risk of short-term mortality and cardiovascular complications after non-traumatic intracerebral hemorrhage, exhibiting a dose-response relationship. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association between admission serum albumin levels and 30-day cardiovascular complications and mortality in adults hospitalized with non-traumatic intracerebral hemorrhage.

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Key result

Low admission albumin is linked to ~28% higher 30-day death and CV complications after intracerebral hemorrhage.

HR 1.28
95% CI 1.26-1.30
P<0.0001
n=241,228

Why the study?

Early cardiovascular complications after non-traumatic ICH contribute to short-term morbidity and mortality, yet reliable prognostic markers remain limited.

Does reduced admission serum albumin predict 30-day cardiovascular complications and mortality in adults with non-traumatic intracerebral hemorrhage?

Key Points

To evaluate the association between admission serum albumin levels and 30-day cardiovascular complications and mortality in adults hospitalized with non-traumatic intracerebral hemorrhage.
Conducted a retrospective cohort study using the TriNetX US Collaborative Network of 241,228 adult patients hospitalized with intracerebral hemorrhage who had serum albumin measured within 24 h of admission.
Applied 1:1 propensity score matching on baseline demographics, cardiovascular comorbidities, hemorrhage severity, neurosurgical interventions, and medications, retaining 79,751 patients in the reduced albumin group (≤3.4 g/dL) and 79,751 in the normal albumin group (≥3.5 g/dL).
The primary composite outcome occurred in 40.4% of patients with reduced albumin compared with 33.3% with normal albumin (HR 1.28, 95% CI 1.26–1.30; p < 0.0001).
Reduced albumin was significantly associated with higher all-cause mortality (22.8% vs 16.0%; HR 1.50, 95% CI 1.46–1.53; p < 0.0001), myocardial infarction (4.5% vs 2.9%; HR 1.36, 95% CI 1.25–1.47; p < 0.0001), and ventricular arrhythmias (2.0% vs 1.5%; HR 1.41, 95% CI 1.31–1.52; p < 0.0001).
A dose–response relationship was observed with severe hypoalbuminemia showing higher composite risk (HR 1.49, 95% CI 1.45–1.54) than mild (HR 1.16, 95% CI 1.14–1.19), whereas atrial fibrillation or flutter showed no significant difference (14.0% vs 14.1%; HR 1.02, 95% CI 0.99–1.05; p = 0.779).

Study Design

Type

Cohort (n=241,228)

Multicenter

Yes

Structured PICO

Does reduced admission serum albumin predict 30-day cardiovascular complications and mortality in adults with non-traumatic intracerebral hemorrhage?

Population

241,228 adults hospitalized with non-traumatic intracerebral hemorrhage in the US who had serum albumin measured within 24 hours of admission, followed for 30 days.

Exposure

Reduced admission serum albumin (≤3.4 g/dL) measured within 24 hours of admission

Comparator

Normal admission serum albumin (≥3.5 g/dL) measured within 24 hours of admission

Outcome

30-day composite of all-cause death, acute myocardial infarction, heart failure, atrial fibrillation or flutter, ventricular arrhythmias, and Takotsubo cardiomyopathycomposite

Main Result

Hazard Ratio: 1.28 (95% CI 1.26–1.3)

Absolute Event Rate: 40.4% vs 33.3%

p-value: p=<0.0001

Reduced admission serum albumin is an independent predictor of early mortality and major cardiovascular complications following non-traumatic intracerebral hemorrhage, extending the concept of stroke-heart syndrome to hemorrhagic stroke.

Limitations

Retrospective observational design subject to unmeasured confounding
Dependence on institutional documentation and coding accuracy
Inability to distinguish primary from secondary non-traumatic hemorrhage
Lack of granular severity metrics like hematoma volume or baseline NIHSS
Competing risk of mortality for non-fatal components
Federated network subject to entry errors, variable completeness, and misclassification
Inability to distinguish primary from secondary non-traumatic hemorrhage using ICD-10 codes
Limited to patients with sufficient healthcare contact for early albumin measurement
Lack of data on hematoma volume, baseline NIHSS, ICH score, or post-index neurological deterioration

Implication

Reduced albumin may flag higher 30-day CV risk in ICH patients; leaves open whether supplementation improves outcomes.

Abstract

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.

Discussion

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Cite This Study

Ghafarian et al. (2026) conducted a cohort in Non-traumatic intracerebral hemorrhage (n=241,228). Reduced admission serum albumin (≤3.4 g/dL) vs. Normal admission serum albumin (≥3.5 g/dL) was evaluated on 30-day composite of all-cause death, acute myocardial infarction, heart failure, atrial fibrillation or flutter, ventricular arrhythmias, and Takotsubo cardiomyopathy (HR 1.28, 95% CI 1.26-1.30, p=<0.0001). Reduced admission serum albumin (≤3.4 g/dL) was associated with a 28% higher hazard of a 30-day composite of death and cardiovascular complications compared to normal albumin in patients with intracerebral hemorrhage.

synapsesocial.com/papers/6a9bd48c6b95aff0620ec3dd https://doi.org/10.3390/jcm15176840

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Implication

Reduced albumin may flag higher 30-day CV risk in ICH patients; leaves open whether supplementation improves outcomes.

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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