Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre.

Details

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State: Public
Version: Final published version
Serval ID
serval:BIB_03EEEB1F3461
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre.
Journal
BMJ open
Author(s)
Labgaa I., Joliat G.R., Kefleyesus A., Mantziari S., Schäfer M., Demartines N., Hübner M.
ISSN
2044-6055 (Electronic)
ISSN-L
2044-6055
Publication state
Published
Issued date
08/04/2017
Peer-reviewed
Oui
Volume
7
Number
4
Pages
e013966
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
To test postoperative serum albumin drop (ΔAlb) as a marker of surgical stress response and early predictor of clinical outcomes.
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).
Department of abdominal surgery in a European tertiary centre.
Adult patients undergoing elective major abdominal surgery, with anticipated duration ≥2 hours. Patients on immunosuppressive or antibiotic treatments before surgery were excluded.
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.
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.

Keywords
Abdomen/surgery, Adult, Aged, Biomarkers, C-Reactive Protein/metabolism, Calcitonin/metabolism, Elective Surgical Procedures/adverse effects, Female, Humans, Male, Middle Aged, Postoperative Complications/metabolism, Postoperative Period, Predictive Value of Tests, Prospective Studies, Protein Precursors, Serum Albumin/metabolism, Switzerland/epidemiology, Biomarker, albumin, major surgery, postoperative complications, stress response
Pubmed
Web of science
Open Access
Yes
Create date
25/04/2017 17:50
Last modification date
20/08/2019 13:25
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