Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions

Abstract

Introduction:Hypoalbuminemia is a well-recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)-induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB-induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes.Materials and Methods:Prospective observational study conducted in 150 patients, Group 1 ≤18 years (n = 75) and Group 2 >18 years (n = 75) of age. Albumin levels were measured preoperatively (T1), after termination of CPB (T2) and 48 h post-CPB (T3). Primary parameters (mortality, duration of postoperative ventilation, duration of inotropes and duration of Intensive Care Unit [ICU] stay) and secondary parameters (urine output, oliguria, arrhythmias, and hemodynamic parameters) were recorded.Results:The albumin levels in Group 1 at T1, T2, and T3 were 3.8 ± 0.48, 3.2 ± 0.45 and 2.6 ± 0.71 mg/dL; and in Group 2 were 3.7 ± 0.50, 3.2 ± 0.49 and 2.7 ± 0.62 mg/dL respectively. All patients showed a significant decrease in albumin concentration 48 h after surgery (P < 0.01). Analysis between the groups, however, showed no statistical difference. Eleven patients expired during the study period, and nonsurvivors showed significantly lower serum albumin concentration 48 h after surgery 2.3 ± 0.62 mg/dL versus 3.7 ± 0.56 mg/dL in the survivors (P < 0.05). Receiver operating characteristic curve showed that a baseline albumin cut-off value of 3.3 g/dL predicts mortality with a positive predictive value 47.6% and a negative predictive value of 99.2% (P < 0.05). A strong correlation was seen between albumin levels at 48 h with duration of CPB (r2 = 0.6321), ICU stay (r2 = 0.7447) and incidence of oliguria (r2 = 0.8803).Conclusions:The study demonstrated similar fall in albumin concentration in cyanotic patients (both adult and pediatric) in response to CPB. Low preoperative serum albumin concentrations (<3.3 g/dL) can be used to identify and prognosticate subset of cyanotics predisposed to additional surgical risk.

Perioperative serum albumin and its influence on clinical outcomes in neonates and infants undergoing cardiac surgery with cardiopulmonary bypass: a multi-centre retrospective study

“…Like the few other studies in the literature that evaluated the association of serum albumin levels on the outcomes in this population, 6,7 we found that post-operative hypoalbuminemia had a univariate association with morbidity. However, in this multi-centre cohort of predominantly neonates, there was no independent association between post-operative hypoalbuminemia and morbidity, despite the larger sample size.…”

“…3,4 Few studies have evaluated the impact of hypoalbuminemia in children with cardiac disease. [5][6][7] In a mixed cohort of adult and paediatric cardiac surgical patients, albumin level decreased after cardiopulmonary bypass and was associated with post-operative morbidity and mortality. 6 Leite et al 7 demonstrated in 30 paediatric cardiac surgical patients that pre-and post-operative albumin <3 g/dl has a univariate association with mortality, postsurgical infection, and longer length of hospital stay.…”

“…[5][6][7] In a mixed cohort of adult and paediatric cardiac surgical patients, albumin level decreased after cardiopulmonary bypass and was associated with post-operative morbidity and mortality. 6 Leite et al 7 demonstrated in 30 paediatric cardiac surgical patients that pre-and post-operative albumin <3 g/dl has a univariate association with mortality, postsurgical infection, and longer length of hospital stay. To date, no studies have evaluated serum albumin level as an independent predictor of morbidity after paediatric cardiac surgery.…”

Preoperative serum albumin: a promising indicator of early mortality after surgery for infective endocarditis

“…Malnutrition is an important factor that regulates albumin production; however, serum albumin is also affected by various non-nutritional factors, such as chronic inflammation, repeated infections, liver failure, renal insufficiency, gastrointestinal function changes, and fluid overload dilution (10). Studies have shown that albumin is also decreased in IE patients (11), and the cause is not only malnutrition but also inflammation, infection, and renal insufficiency.…”

Albumin is a key solution and is administered during paediatric heart surgery

“…It is made from blood donor plasma and functions as a physiological plasma expander. This product is created using the alcohol fractionation process, and infectious pathogens are rendered inactive by heating it to 60 °C for 10 hours [1][2] . Human albumin possesses osmotic or oncotic characteristics, which is the primary basis for its therapeutic use, and it raises plasma volume similarly to crystalloid and colloidal solutions.…”