High dose human serum albumin for the treatment of acute ischemic stroke - A safety study

Introduction. In animal models of focal cerebral ischemia, albumin infusions at doses ranging from 0.6 to 2.5 g/kg are neuroprotective. It is not known whether patients with stroke, often elderly and with underlying cardiovascular disease, can safely tolerate such degrees of volume expansion. Therefore, we retrospectively reviewed the safety of high-dose albumin treatment in patients with acute ischemic stroke. Materials and Methods: Within 24 hours of ischemic stroke onset, patients who received at least 0.7 g/kg albumin were identified by a review of medical records. Each albumin recipient was assigned two control patients, who received standard fluid management. Controls were matched by age, number of stroke risk factors, stroke severity, and stroke subtype. Medical records were reviewed for treatment-related adverse events, defined as cardiopulmonary complications and mortality. Results: Thirty cases (mean age 62.9 +/- 11.4 years) and 60 controls (mean age 62.5 +/- 11.8 years) were identified between July 1999 and November 2001. The two groups were evenly matched. The mean dose of albumin infusion was 171 g (2.4 g/kg). Cardiopulmonary complications or death developed in 37% of cases and 18% of controls (p = 0.056). Mortality was 7% in both groups. Multivariate regression analysis showed that a history of congestive heart failure and higher total albumin dose were independently associated with the occurrence of adverse events. Conclusion: Albumin treatment was associated with a nonsignificant trend toward increased cardiopulmonary adverse events. However, these adverse events did not result in excess mortality.