Preoperative Serum Albumin but Not Prealbumin Is an Excellent Predictor of Postoperative Complications and Mortality in Patients with Gastrointestinal Cancer

Abstract

Preoperative serum albumin level is well recognized as a general predictor of adverse surgical outcomes in patients with gastrointestinal (GI) malignancy. Whether serum albumin or prealbumin levels can better predict postoperative surgical complications and death remains unknown. A retrospective review of 641 consecutive patients operated nonemergently for GI malignancies between January 1, 1997, and July 31, 2008, disclosed that 104 patients (16.2%) had complications and 23 (3.6%) subsequently died. All 641 patients had preoperative determination of serum albumin level (cost $0.13 per test), whereas 379 (59.1%) also had preoperative determination of serum prealbumin level (cost $2.27 per test). An albumin level below the discriminatory threshold of 3.2 g/dL was a significant predictor of overall postoperative morbidity, infectious and noninfectious complications, and mortality (all P < 0.001). In contrast, a prealbumin level below the discriminatory threshold of 18 mg/dL was a predictor of only overall morbidity ( P = 0.014) and infectious complications ( P = 0.024), but not of noninfectious complications or mortality ( P = nonsignificant). We conclude that compared with the preoperative serum prealbumin level, the albumin level has superior predictive value for overall postoperative morbidity, both infectious and noninfectious complications, and mortality. The inclusion of serum prealbumin level in the routine preoperative testing of patients with GI malignancy for the purpose of predicting postoperative outcomes is neither clinically necessary nor cost-effective.

Serum Prealbumin and Echocardiography Parameters Predict Mortality in Peritoneal Dialysis Patients

“…Whether the serum PAB concentration is a more accurate indicator of nutritional status and an independent mortality predictor compared to previous markers, i.e., albumin and BMI, has been a matter of debate. This controversy persists with respect to the general population [27][28][29] and patients with various conditions [26,[30][31][32]. In present study, when other nutritional markers (albumin, cholesterol, and BMI) were included into Cox regression models, no difference was found in the association between serum PAB and overall mortality.…”

Low prealbumin is a significant predictor of medical complications in severe anorexia nervosa

“…In patients with chronic hemodialysis, for instance, numerous studies have shown that lower prealbumin levels are independently associated with morbidity and mortality, independent of serum albumin level or other clinical risk factors . On the other hand, several other studies have argued that albumin is the key marker for mortality, rather than prealbumin . As first reported in a 1936 study of patients undergoing ulcer surgery, malnutrition affects outcomes in surgical patients .…”

Preoperative Platelet–to–Albumin Ratio Predicts Prognosis of Patients with Pancreatic Ductal Adenocarcinoma After Pancreatic Resection

“…In addition, metastatic tumor cells induce Kupffer cells in the liver to produce cytokines, and reduce albumin synthesis (29). Consequential hypoalbuminemia is also correlated with impairment of a variety of immune system functions (30), and helps tumor cell promotion and metastasis as a result.…”