Increased Cysteinylated Albumin is Associated with More Favorable Outcomes in Ischemic Stroke Patients, A Reflection of Collateral Circulation? (P1.261)

Objective: To determine whether admission albumin levels and the cysteinylation of albumin in acute ischemic stroke (AIS) patients were associated with stroke severity and outcomes.

Background: Studies have shown an association between low serum albumin and poor outcomes in AIS patients. Cysteinylation of albumin is the result of oxidation of its only free cysteine (cys34) which accounts for the majority of reductant capacity in plasma.

Design/Methods: At a Comprehensive Stroke Center, plasma samples were prospectively collected (2010–2011), and clinical data were abstracted for AIS patients (n=107). Cysteinylation of serum albumin (% of total albumin) was measured in AIS patients and healthy controls (n=12) using HPLC coupled to mass spectrometry; this was used to calculate the actual level of cysteinylated albumin (admission albumin × % cysteinylated). ANOVA or Chi-square trend tests were used to examine the association between stroke severity, outcomes (length of stay [LOS], discharge mRS≤2, in-hospital mortality) and quartile of albumin and cysteinylated albumin.

Results: Elevated levels of cysteinylated albumin were detected in AIS patients (40.7±7.8%) compared to the controls (32.3±3.5%), p<0.001. No association was found between stroke severity or LOS and albumin or cysteinylated albumin. Increasing albumin (≤3.10 mg/ml, >3.10–3.45 mg/ml, >3.45–3.85 mg/ml, >3.85 mg/ml) at admission was associated with decreasing mortality (15.6%, 12.5%, 8.3%, 0%, p = 0.047). Cysteinylated albumin was associated with discharge mRS and mortality. As the cysteinylated albumin increased (≤1.17 mg/ml, >1.17–1.37 mg/ml, >1.37–1.63 mg/ml, >1.63 mg/ml), the percent of patients with a discharge mRS≤2 increased (24.0%, 30.4%, 41.7%, 58.3%, p=0.01), while in-hospital mortality decreased (16.0%, 17.4%, 4.2%, 0%, p=0.02).

Conclusions: Increasing levels of cysteinylated albumin were associated with more favorable discharge mRS and less mortality. Cysteinylated (oxidized) albumin may reflect the presence of collateral circulation in equilibrium with the peripheral circulation from where venous blood samples were obtained for this study.

Disclosure: Dr. Bartt has nothing to disclose. Dr. Leonard has nothing to disclose. Dr. Bar-Or has nothing to disclose. Dr. Rael has nothing to disclose. Dr. Bar-Or has nothing to disclose.