ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurorehabilitation
Association of Serum Albumin Levels with Multidomain Functional Impairment (Motor, Balance, ADL, and Cognitive Impairment) in Chinese Post-Stroke Patients: A Multicenter Cross-Sectional Study
Jie Zhu 1
Ranran Bi 2
Yansheng Lin 3
Shuyang Zhang 4
Yifang Lin 1
Xuezhen Zhao 1
Jiali Lin 4
Jie Jia 1,5
1. Huashan Hospital, Fudan University, Shanghai, China
2. The East Hospital Affiliated to Tongji University, Shanghai, China
3. Fujian University of Traditional Chinese Medicine, Fuzhou, China
4. The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
5. Huashan Hospital Fudan University National Clinical Research Center for Aging and Medicine, Shanghai, China
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Abstract
Background: Malnutrition, frequently indicated by hypoalbuminemia, is prevalent post-stroke and associated with adverse functional outcomes. However, the independent role of serum albumin (ALB) in multidomain functional recovery—encompassing motor, balance, cognitive, and daily living domains—remains underexplored in Chinese populations. This multicenter study aimed to quantify the independent association between serum ALB levels and functional impairment in Chinese post-stroke patients. Methods: In this cross-sectional study, 1,741 patients from rehabilitation centers across China were enrolled. ALB levels were categorized into quartiles (Q1: <37.7 g/L; Q2: 37.7–40.0 g/L; Q3: 40.0–42.8 g/L; Q4: ≥42.8 g/L). Outcomes included motor function (Fugl-Meyer Assessment), activities of daily living (Modified Barthel Index), balance (Berg Balance Scale), and cognition (Montreal Cognitive Assessment). Multivariable linear regression models adjusted for demographics, comorbidities, lesion characteristics, and illness duration. Subgroup analyses tested interactions by age, sex, BMI, and lesion topography. Results: Each 1-g/L ALB increase independently predicted functional gains: FMA (β = 1.35, 95% CI: 0.99–1.72), ADL (β = 1.77, 1.44–2.10), BBS (β = 1.02, 0.78–1.26), MoCA (β = 0.30, 0.21–0.40) (all P < 0.001). Dose-dependent improvements were observed across quartiles (Q4 vs. Q1: FMA Δβ = 15.11 [11.09–19.12]; ADL Δβ = 19.35[15.76–22.93]; Ptrend < 0.001). Sex significantly modified ALB-FMA associations (Pinteraction = 0.017), with females showing stronger effects (β = 1.81 [1.12–2.51]) than males (β = 1.15 [0.72–1.58]). Cerebellar lesions demonstrated non-significant trend toward amplified associations (FMA: β = 2.16 [0.72–3.59]). Conclusions: ALB levels are independently and dose-dependently associated with motor, ADL, balance, and cognitive function in post-stroke patients. Compared to lower quartiles, patients with ALB ≥42.8 g/L (highest quartile) exhibit superior functional outcomes. A sex-specific pattern is observed solely in motor function, where the correlation is more pronounced in females. ALB may serve as a biological indicator for risk stratification during stroke rehabilitation.
Summary
Keywords
Activities of Daily Living (ADL), Fugl-Meyer assessment (FMA), functional recovery, Serum Albumin, stroke rehabilitation
Received
09 December 2025
Accepted
09 February 2026
Copyright
© 2026 Zhu, Bi, Lin, Zhang, Lin, Zhao, Lin and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jie Jia
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