{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:53:23Z","timestamp":1791978803598,"version":"4.4.0"},"reference-count":43,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Open"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Aim<\/jats:title>\n Frailty is associated with adverse stroke outcomes. This study aimed to examine whether hypoalbuminemia mediates this association.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n A prospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 175 patients with stroke admitted to a tertiary hospital between March and November 2023 were included. Frailty was assessed within 24\u2009h of admission using the Clinical Frailty Scale (CFS) and categorised as frail (CFS \u2265\u20095) or non\u2010frail (CFS \u2264\u20094). Demographic, clinical and biochemical data were collected. Hypoalbuminemia (serum albumin <\u200935\u2009g\/L) was determined based on the lowest serum albumin level during hospitalisation. Functional outcomes were evaluated using the modified Rankin Scale (mRS) at discharge, 30\u2009days and 90\u2009days after discharge, with scores \u2264\u20093 defined as good outcome and >\u20093 as poor outcome.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 175 stroke patients included in the study, 52 (29.71%) were frail and 64 (36.57%) developed hypoalbuminemia during hospitalisation. The proportions of poor outcomes were 47.43% at discharge, 42.86% at 30\u2009days and 37.14% at 90\u2009days after discharge. After adjusting for confounding factors, frailty was significantly associated with the occurrence of hypoalbuminemia [relative risk (RR)\u2009=\u20091.61, 95% confidence interval (CI): 1.08\u20132.40,\n p<\/jats:italic>\n \u2009=\u20090.019]. Frailty was also significantly associated with poor outcomes at discharge (RR\u2009=\u20091.56, 95% CI: 1.12\u20132.16,\n p<\/jats:italic>\n \u2009=\u20090.008), at 30\u2009days (RR\u2009=\u20092.02, 95% CI: 1.41\u20132.89,\n p<\/jats:italic>\n \u2009<\u20090.001) and at 90\u2009days (RR\u2009=\u20092.79, 95% CI: 1.81\u20134.30,\n p<\/jats:italic>\n \u2009<\u20090.001). Hypoalbuminemia was also independently associated with poor outcomes at all time points (all\n p<\/jats:italic>\n \u2009<\u20090.05). Mediation analysis showed that hypoalbuminemia partially mediated the association between frailty and poor outcomes, with mediation proportions of 22.21%, 16.85% and 14.03% at discharge, 30\u2009days and 90\u2009days, respectively (all\n p<\/jats:italic>\n \u2009<\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Hypoalbuminemia partly mediates the impact of frailty on poor outcomes in stroke patients. The findings suggest that nurses should place greater emphasis on frailty assessment and serum albumin monitoring in patients with stroke to facilitate the early identification of high\u2010risk patients and to inform individualised nursing assessment and management.<\/jats:p>\n <\/jats:sec>\n \n Reporting Method<\/jats:title>\n The research findings are reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies.<\/jats:p>\n <\/jats:sec>\n \n Patient or Public Contribution<\/jats:title>\n No patient or public contribution.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/nop2.70763","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:37:34Z","timestamp":1791977854000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Mediating Role of Hypoalbuminemia in the Association Between Frailty and Poor Outcomes in Stroke Patients"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4824-9521","authenticated-orcid":false,"given":"Jiajia","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology Center for Immune Ageing and Rejuvenation, The First Affiliated Hospital of Chongqing Medical University Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4786-7050","authenticated-orcid":false,"given":"Feng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2820-9611","authenticated-orcid":false,"given":"Jingjing","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The First Affiliated Hospital of Chongqing Medical University Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3111-699X","authenticated-orcid":false,"given":"Junzhuo","family":"Li","sequence":"additional","affiliation":[{"name":"Tianjin Medical University Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuhong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Chongqing Business Vocational College Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yetao","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Nosocomial Infection Control The Second Affiliated Hospital of Army Medical University Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1957-4332","authenticated-orcid":false,"given":"Nuanjiao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2999-9356","authenticated-orcid":false,"given":"Guangwei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"8","key":"e_1_2_15_2_1","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s00228-024-03664-y","article-title":"Albumin: A Comprehensive Review and Practical Guideline for Clinical Use","volume":"80","author":"Abedi F.","year":"2024","journal-title":"European Journal of Clinical Pharmacology"},{"key":"e_1_2_15_3_1","first-page":"53","article-title":"Low Admission Serum Albumin as Prognostic Determinant of 30\u2010Day Case Fatality and Adverse Functional Outcome Following Acute Ischemic Stroke","volume":"14","author":"Abubakar S.","year":"2013","journal-title":"Pan African Medical Journal"},{"issue":"3","key":"e_1_2_15_4_1","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1161\/01.STR.0000258355.23810.c6","article-title":"Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials: A Literature Review and Synthesis","volume":"38","author":"Banks J. 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