Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre.
- Labgaa I Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Joliat GR Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Kefleyesus A Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Mantziari S Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Schäfer M Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Demartines N Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- Hübner M Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland.
- 2017-04-10
Published in:
- BMJ open. - 2017
Biomarker
albumin
major surgery
postoperative complications
stress response
Abdomen
Adult
Aged
Biomarkers
C-Reactive Protein
Calcitonin
Elective Surgical Procedures
Female
Humans
Male
Middle Aged
Postoperative Complications
Postoperative Period
Predictive Value of Tests
Prospective Studies
Protein Precursors
Serum Albumin
Switzerland
English
OBJECTIVE
To test postoperative serum albumin drop (ΔAlb) as a marker of surgical stress response and early predictor of clinical outcomes.
DESIGN
Prospective cohort study (NCT02356484). Albumin was prospectively measured in 138 patients undergoing major abdominal surgery. Blood samples were collected before surgery and on postoperative days 0, 1 2 and 3. ΔAlb was compared to the modified estimation of physiologic ability and surgical stress (mE-PASS) score and correlated to the performances of C reactive protein (CRP), procalcitonin (PCT) and lactate (LCT). Postoperative outcomes were postoperative complications according to Clavien classification and Comprehensive Complication Index (CCI), and length of hospital stay (LoS).
SETTING
Department of abdominal surgery in a European tertiary centre.
PARTICIPANTS
Adult patients undergoing elective major abdominal surgery, with anticipated duration ≥2 hours. Patients on immunosuppressive or antibiotic treatments before surgery were excluded.
RESULTS
The level of serum albumin rapidly dropped after surgery. ΔAlb correlated to the mE-PASS score (r=0.275, p=0.01) and to CRP increase (r=0.536, p<0.001). ΔAlb also correlated to overall complications (r=0.485, p<0.001), CCI (r=0.383, p<0.001) and LoS (r=0.468, p<0.001). A ΔAlb ≥10 g/L yielded a sensitivity of 77.1% and a specificity of 67.2% (AUC: 78.3%) to predict complications. Patients with ΔAlb ≥10 g/L on POD 1 showed a threefold increased risk of overall postoperative complications.
CONCLUSIONS
Early postoperative decrease of serum albumin correlated with the extent of surgery, its metabolic response and with adverse outcomes such as complications and length of stay. A decreased concentration of serum albumin ≥10 g/L on POD 1 was associated with a threefold increased risk of overall postoperative complications and may thus be used to identify patients at risk.
To test postoperative serum albumin drop (ΔAlb) as a marker of surgical stress response and early predictor of clinical outcomes.
DESIGN
Prospective cohort study (NCT02356484). Albumin was prospectively measured in 138 patients undergoing major abdominal surgery. Blood samples were collected before surgery and on postoperative days 0, 1 2 and 3. ΔAlb was compared to the modified estimation of physiologic ability and surgical stress (mE-PASS) score and correlated to the performances of C reactive protein (CRP), procalcitonin (PCT) and lactate (LCT). Postoperative outcomes were postoperative complications according to Clavien classification and Comprehensive Complication Index (CCI), and length of hospital stay (LoS).
SETTING
Department of abdominal surgery in a European tertiary centre.
PARTICIPANTS
Adult patients undergoing elective major abdominal surgery, with anticipated duration ≥2 hours. Patients on immunosuppressive or antibiotic treatments before surgery were excluded.
RESULTS
The level of serum albumin rapidly dropped after surgery. ΔAlb correlated to the mE-PASS score (r=0.275, p=0.01) and to CRP increase (r=0.536, p<0.001). ΔAlb also correlated to overall complications (r=0.485, p<0.001), CCI (r=0.383, p<0.001) and LoS (r=0.468, p<0.001). A ΔAlb ≥10 g/L yielded a sensitivity of 77.1% and a specificity of 67.2% (AUC: 78.3%) to predict complications. Patients with ΔAlb ≥10 g/L on POD 1 showed a threefold increased risk of overall postoperative complications.
CONCLUSIONS
Early postoperative decrease of serum albumin correlated with the extent of surgery, its metabolic response and with adverse outcomes such as complications and length of stay. A decreased concentration of serum albumin ≥10 g/L on POD 1 was associated with a threefold increased risk of overall postoperative complications and may thus be used to identify patients at risk.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1136/bmjopen-2016-013966
- PMID 28391235
- Persistent URL
- https://folia.unifr.ch/global/documents/25522
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