Hypoalbuminemia and colorectal cancer patients: Any correlation?: A systematic review and meta-analysis

Abstract

Background: In malnourished patients with colorectal cancer, hypoalbuminemia is common and was proposed to determine the postoperative outcome of colorectal surgery. Mounting articles published but have not been evaluated. We aim to assess the predictive value of preoperative hypoalbuminemia in patients undergoing colorectal surgery.Methods: We performed a literature search from PubMed, Euro PMC, and Cochrane with the terms serum albumin, hypoalbuminemia, prognosis, outcome, colorectal cancer, and neoplasm. We also hand-searched and included any relevant papers. Hypoalbuminemia is defined as plasma albumin level < 3.5 mg/dL. We restricted the included studies to English language and adults undergoing colectomy, laparotomy, laparoscopy, or abdominoperineal resection. Any types of articles were included, except an abstract-only publication and those that did not report the key exposure or outcome of interest. The key exposures were mortality, hospitalization time, and morbid conditions (thrombosis, surgical site infection, sepsis, and wound events). We pooled the odds ratio from each included literature as effect size. The Newcastle Ottawa scale and GRADE were used to determine the quality of each included study.Results: Hereof 7 observational studies (236,480 individuals) were included. Our meta-analysis found that preoperative hypoalbuminemia can predict the postoperative outcome in colorectal cancer patients. Individuals with hypoalbuminemia were not associated with 30-day mortality (risk ratio [RR] 2.05 [0.72, 5.86], P = .18, I 2 = 99%) but were associated with morbidity (RR 2.28 [1.78,2.93], P < .00001, I 2 = 87.5%), surgical complication (RR 1.69 [1.34,2.13], P < .00001, I 2 = 98%), and hospitalization (RR 2.21 [1.93,2.52], P < .00001, I 2 = 0%). According to newcastle ottawa scale, the included studies are of moderate to sound quality. Conclusions:The current systematic review and meta-analysis showed that preoperative hypoalbuminemia was significantly associated with morbidity, length of stay, and surgical complication but not mortality.Abbreviations: BSA = basal serum albumin, CRC = colorectal cancer, NOS = newcastle ottawa scale, RR = risk ratio.

Impact of Preoperative Serum Albumin Level on the Outcome of Colorectal Cancer Surgery

“…Based on our study’s findings, we can conclude that preoperative serum albumin level is a useful prognostic biomarker for CRC patient outcomes after surgery. These findings are aligned with previous studies in the literature that have shown the association between hypoalbuminemia and poor surgical outcomes [ 10 - 12 ]. One example of such studies is a paper that analyzed patients who have undergone significant gastrointestinal surgery [ 13 ].…”

Role of Age as a Predictor of Major Complications After Elective Surgery for Ulcerative Colitis

“…25 The impact of preoperative hypoalbuminemia on surgical outcomes has long been established for colorectal and non-colorectal surgery. [26][27][28] Supporting our findings, a recent retrospective analysis of 208 patients who underwent surgery for UC also found that preoperative transfusion and preoperative hypoalbuminemia (≤2.4 g/ dl, in said study) were predictors of severe complications and SSI. 29 We showed that hypoalbuminemia impacts postoperative morbidity in all patients, regardless of age.…”

Prognostic Ability of Nutritional Indices for Outcomes of Bladder Cancer: A Systematic Review and Meta-Analysis

“…Malnutrition can directly influence host immunity and, therefore, cancer outcomes [39]. Individually, hypoalbuminemia alone has been associated with poor prognosis in cancer patients [11]; however, since other confounders and diseases can easily alter albumin levels, it has now been used in combination with other variables. Combination with lymphocytes generates an immune-nutrition marker (PNI) as lymphocyte counts are reflective of cell-mediated immunity and are a vital component of cancer defense.…”

“…Evidence shows poor survival, increased complications, and higher healthcare costs among cancer patients suffering from malnutrition [6]. Given that up to 71% of cancer patients may be malnourished before treatment [7], a plethora of research is being conducted to accurately identify malnourished cancer patients so that early interventions can be administered to improve prognosis [8][9][10][11][12]. Nevertheless, there is no clarity on which is the best biomarker for identifying malnutrition and predicting outcomes in cancer patients [13].…”