Urinary microalbumin levels linked with early neurological deterioration in patients with acute ischemic stroke: Study

A recent study published in the Journal of Stroke and Cerebrovascular Diseases found positive correlation between urinary microalbumin (U-Alb) levels and early neurological deterioration (END) in patients with acute ischemic stroke (AIS). The findings suggest U-Alb as a promising predictive marker, particularly for certain etiological subtypes of AIS.

This research enrolled a total of 615 patients with AIS within 72 hours of symptom onset after collecting comprehensive clinical data and baseline laboratory metrics, including U-Alb levels. END, defined as an increase of at least 4 points in the NIH Stroke Scale (NIHSS) within the first 72 hours, served as the primary outcome. Using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria, the patients were categorized into distinct etiological subtypes as large artery atherosclerosis, small artery occlusion and cardioembolism. The team utilized binary logistic regression to explore the relationship between baseline U-Alb and END occurrence and conducted ROC curve analysis to assess the predictive capabilities of U-Alb for each subtype.

The study revealed that 16.9% (104 patients) experienced END. Elevated U-Alb levels were independently associated with END, with an odds ratio (OR) of 1.009 (95% CI: 1.002–1.016, p = 0.009). ROC analysis further underlined the predictive ability of U-Alb, particularly for patients with small artery occlusion (AUC = 0.707, p < 0.001) and large artery atherosclerosis (AUC = 0.632, p = 0.006). The optimal U-Alb diagnostic thresholds for these groups were 31.11 mg/L and 25.71 mg/L, respectively.

U-Alb was not found to be a significant independent risk factor for END in the patients with cardioembolic stroke (OR = 1.011, p = 0.478). This study also established a positive correlation between U-Alb levels and infarct volume (r = 0.516, p < 0.01), linking microalbuminuria (MAU) to stroke progression (p = 0.023).

Overall, the findings of this study highlight the potential of U-Alb as a biomarker for predicting END in patients with small artery occlusion. These insights could guide clinicians in early risk stratification and management of AIS by emphasizing the need for targeted therapeutic interventions in vulnerable subgroups. While the predictive ability of U-Alb is less robust for other etiological subtypes, the study highlights its broader relevance to understanding stroke progression and tailoring patient care.

Source:

Huang, H., Jiang, X.-F., Yang, X.-Y., & Liu, Y. (2024). Urinary Microalbumin predicts early neurological deterioration in acute ischemic stroke: A study based on etiological classification. In Journal of Stroke and Cerebrovascular Diseases (Vol. 33, Issue 12, p. 108044). Elsevier BV. https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.108044