Cilostazol Treatment and Serum Albumin Concentration in Patients with Aneurysmal Subarachnoid Hemorrhage
Adnan Qureshi1, Shinsuke Muraoka2, Ryuta Saito3, Abdullah Lodhi4, Hamza Maqsood4, Jonathan Beall5, Christy Cassarly5, Byron Gajewski6, Renee Martin5, Jose Suarez7
1Zeenat Qureshi Stroke Institute, 2Nagoya University Graduate School of Medicine, 3Tohoku University Graduate School of Medicine, 4University of Missouri, 5Medical University of South Carolina, 6University of Kansas Medical Center, 7The Johns Hopkins University
Objective:
We aimed to identify potential synergy between cilostazol use and serum albumin concentration measures in aneurysmal subarachnoid hemorrhage (aSAH) patients.
Background:
Cilostazol reduces the risks of cerebral ischemia related to vasospasm, angiographic vasospasm, new cerebral infarction, and death or disability in clinical studies. Higher serum albumin concentrations and IV albumin infusions are associated with reduction in occurrence of cerebral ischemia and the rate of death or disability in aSAH patients.
Design/Methods:
We analyzed data from a retrospective, observational cohort study using data from aSAH patients. We determined the effect of cilostazol use, baseline albumin concentration and magnitude of serum albumin concentration reduction within 2 weeks post aSAH on cerebral ischemia related to vasospasm and functional independence at discharge (modified Rankin scale [mRS] 0-2) and identified any interaction between cilostazol use and serum albumin measures after adjusting for potential confounders.
Results:
Cilostazol use (odds ratio [OR]= 2.37) and baseline albumin concentration (OR= 5.15) were associated with higher odds (non-significant) of functional independence at discharge after adjusting for potential confounders. The magnitude of serum albumin concentration reduction was associated with lower odds functional independence at discharge (OR 0.06, 95% CI 0.002—0.77, p = 0.05). The interaction between cilostazol use and magnitude of serum albumin concentration reduction was significant (p=0.03). Among patients treated with cilostazol, one-unit reduction in magnitude of serum albumin concentration was associated with a median increase of approximately 3.3333 (95% CI -0.4621 to 4.2756) in the mRS at discharge.
Conclusions:
Our analysis raises the possibility that intravenous albumin infusion to ameliorate reduction in magnitude of serum albumin concentration may increase the rate of functional independence in aSAH patients.