Albumin and the fibrinogen-to-albumin ratio: Biomarkers for the acute phase response following total knee arthroplasty

Abstract

Purpose Complications following total knee arthroplasty (TKA) lead to patient morbidity and cost. While acute phase reactants, such as c-reactive protein (CRP) and fibrinogen, have been used to predict complications following TKA, the extent and duration of changes in albumin levels following TKA are unknown. It is hypothesized that like CRP and fibrinogen, albumin, and the fibrinogen/albumin ratio (FAR) represent useful measures of the acute phase response (APR) following TKA. The purpose of this study was to describe the longitudinal course of albumin and FAR in healthy patients following TKA, relative to established biomarkers, and examine if the variance in albumin or FAR correlates with patient comorbidities. Methods This retrospective cohort study of patients undergoing TKA at a tertiary medical center. CRP, fibrinogen, and albumin values were collected pre- and post-operatively. An age-adjusted Charlson comorbidity index (CCI) was utilized as a measure of patient comorbidity status. Results The median preoperative albumin value was 4.3 g/dL, which dropped to 3.6 g/dL on postoperative day 1 following TKA. The albumin value returned to 93% of the baseline by postoperative week 2. The course of albumin inversely mirrored the course of CRP (r = -0.41). Median preoperative FAR was 0.087 g/L, which rose to 0.130 g/L by postoperative week 2 and returned to baseline by postoperative week 6. While preoperative FAR strongly correlated with postoperative week 2 values (r = 0.74), there was a weak positive correlation between age-adjusted CCI and pre-operative FAR (r = 0.24) in patients undergoing primary TKA. Conclusion Albumin levels follow a predictable postoperative decline that inversely correlates with CRP in healthy patients following TKA. Given the low cost and abundance of laboratories offering albumin levels, direct albumin levels and/or albumin ratios such as FAR may be underutilized biomarkers for monitoring the APR following TKA.

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“…After the enrichment analysis, we found that genes have an important role in the acute phase response. It is known that acute phase responses are the body’s response to tissue damage, and acute phase responses may stimulate the initiation of the immune response ( 10 , 11 ). Thus, we analyzed the relationship between the seven genes in THCA and immune infiltration.…”

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“…Meanwhile, fibrinogen is a long-acting plasma acute-phase reactant (33), and the change in albumin level has been Flowchart of this study. A total of 1,216 pregnant women enrolled in our study were selected by inclusion criteria.…”

“…attributed to the changes in nutritional status; furthermore, hypoalbuminemia represents a chronic inflammatory state caused by malnutrition (33,34). Likewise, FAR has been proven to be a more powerful inflammatory-based prognostic predictor of overall survival than other single prognostic markers (35)(36)(37); compared with healthy pregnancies, FAR was considered to be an independent risk factor for predicting spontaneous abortion, and increased FAR levels were considered to be related to the thrombotic process in recurrent abortion (38,39).…”

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“…Additionally, FAR is a predictor of diabetic kidney disease with better performance than fibrinogen and albumin alone [55]. It also reflects the activity of ANCAassociated vasculitis [56], or the acute-phase response after total knee arthroplasty [57]. Similarly, BAR was shown to be a predictor of long-term mortality in patients with acute myocardial infarction in the intensive care unit [58], as well as hospital mortality in older adults [59] or patients with acute pulmonary thromboembolism [60].…”