The influence of postoperative albumin levels on the outcome of cardiac surgery

Abstract

Background: The prognostic role of low postoperative serum albumin levels (SAL) after cardiac surgery (CS) remains unclear in patients with normal preoperative SAL. Our aim was to evaluate the influence of SAL on the outcome of CS. Methods: Prospective observational study. Patients undergoing CS with normal preoperative SAL and nutritional status were included and classified into different subgroups based on SAL at 24 h after CS. We assessed outcomes (i.e., in-hospital mortality, postoperative complications and long-term survival) and results were analyzed among the different subgroups of SAL. Results: We included 2818 patients. Mean age was 64.5 ± 11.6 years and body mass index 28.0 ± 4.3Kg•m − 2. 5.8%(n = 162) of the patients had normal SAL levels(≥35 g•L − 1), 32.8%(n = 924) low deficit (30-34.9 g•L − 1), 44.3%(n = 1249) moderate deficit (25-29.9 g•L − 1), and 17.1%(n = 483) severe deficit(< 25 g•L − 1). Higher SAL after CS was associated with reduced in-hospital (OR:0.84;95% CI:0.80-0.84; P = 0.007) and long-term mortality (HR: 0.85;95% CI:0.82-0.87;P < 0.001). Subgroups of patients with lower SAL showed worst long-term survival (5-year mortality:94.3% normal subgroup, 87.4% low, 83.1% moderate and 72.4% severe;P < 0.001). Multivariable analysis showed higher in-hospital mortality, sepsis, hemorrhage related complications, and ICU stay in subgroups of patients with lower SAL. Predictors of moderate and severe hypoalbuminemia were preoperative chronic kidney disease, previous CS, and longer cardiopulmonary bypass time. Conclusions: The presence of postoperative hypoalbuminemia after CS is frequent and the degree of hypoalbuminemia may be associated with worst outcomes, even in the long-term scenario.

Hypoalbuminemia as Surrogate and Culprit of Infections

“…Preexisting hypoalbuminemia is a prognostic indicator of worse outcome for a broad spectrum of diseases ranging from medical conditions [ 64 , 65 , 66 ] to surgery [ 67 ]. Evidence in support of a prognostic role of serum albumin level is abundant and established for orthopedic [ 68 , 69 , 70 , 71 ], cardiovascular [ 72 , 73 ], gynecologic [ 74 , 75 ], and visceral surgery [ 76 , 77 , 78 ].…”

Morbidity and Mortality Markers in Elderly Patients with Cardiovascular Surgery

“…Although there are many prognostic markers being used to evaluate surgical patients in the literature, these markers are still being investigated for elderly patients. Today, there are studies evaluating the effects of easily observable laboratory parameters on postoperative morbidity and mortality, as well as markers such as age, BMI, accompanying comorbidities, and Euroscore which are widely used in the middle age group [4,[6][7][8][9] . It has been emphasized that the presence of preoperative anemia (<13g / dl regardless of gender) is a very strong indicator of mortality in surgical patients [10][11][12] .…”

Postoperative 20% albumin vs standard care and acute kidney injury after high-risk cardiac surgery (ALBICS): study protocol for a randomised trial

“…Hypoalbuminaemia is common after cardiac surgery. A large observational study ( n = 2818) found that 94% of patients with normal preoperative serum albumin levels developed hypoalbuminaemia at 24 h after cardiac surgery, where the risk of AKI approximately doubled with each 5 g/l reduction [ 19 ].…”