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

Abstract

ObjectiveTo test postoperative serum albumin drop (ΔAlb) as a marker of surgical stress response and early predictor of clinical outcomes.DesignProspective 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).SettingDepartment of abdominal surgery in a European tertiary centre.ParticipantsAdult patients undergoing elective major abdominal surgery, with anticipated duration ≥2 hours. Patients on immunosuppressive or antibiotic treatments before surgery were excluded.ResultsThe 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.ConclusionsEarly 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.

Changes in plasma albumin levels in early detection of infectious complications after laparoscopic colorectal cancer surgery with ERAS protocol

“…This is different from previously published data, where a 20–35% drop was observed [12, 13]. In these studies, however, the greatest decrease in albumin level was observed in patients undergoing liver surgery [19].…”

“…Relatively few publications analysed it as a potential marker of early adverse events, and therefore it is seldom used as a biomarker of complications [12, 13, 19, 20]. However, albumin, which is considered a negative acute phase protein with a half-life of 20 days, seems to have perfect characteristics for a useful biomarker [19].…”

“…An albumin drop is observed in most major abdominal surgeries within the first postoperative hours [10–12]. Although pathophysiological basics of albumin kinetics are well-established, this parameter is rarely used as a marker of complications in the early postoperative period.…”

Compromised Activation of Vitamin D After Elective Surgery: A Prospective Pilot Study

“…The lack of PTH response indicates that calcium in conjunction with other factors may blunt the normal PTH response. Calcium is a known regulator of 1‐alpha hydroxylase activity and PTH secretion . Albumin corrected calcium increased significantly after surgery and could theoretically augment the observed 35% decrease in serum 1,25(OH) 2 D 3 .…”

“…Injury or trauma induces a series of metabolic, inflammatory, and endocrine changes known as the “surgical stress response.” A particular and abrupt event in response to surgery is a profound change in the distribution of proteins between the intra‐ and extravascular compartments . This redistribution gives rise to an instant reduction in the concentration of most circulating proteins, which necessitates immediate changes in factors dependent on protein binding in serum, for instance, calcium and steroid hormones …”