The Temporal Pattern of Fibrinogen and Albumin Synthesis Rates Perioperatively in Major Abdominal Surgery

Abstract

Background: Plasma fibrinogen and albumin concentrations decrease initially after abdominal surgery. On postoperative days 3-5 fibrinogen concentration returns to preoperative level or even higher, while albumin stays low. Fibrinogen and albumin synthesis may be affected differently following major abdominal surgery related to injury and/or loss of liver tissue.The objective of the study was to determine fibrinogen and albumin quantitative synthesis rates in patients undergoing hepatectomies or pancreatectomies with intact liver size.Methods: Patients undergoing liver or pancreatic resection (n=9+6) were studied preoperatively, on postoperative days 1 and 3-5. De novo syntheses of fibrinogen and albumin were determined using the flooding dose technique with 2H5-phenylalanine as a tracer. In addition, several biomarkers indicative of fibrinogen utilization were monitored.Results: After hemi-hepatectomy, fibrinogen synthesis was 2-3-fold higher on postoperative day 1 than preoperatively. On postoperative days 3-5 the synthesis level was still higher than preoperatively. Following major liver resections albumin synthesis was not altered postoperatively compared to preoperative values. After pancreatic resection, on postoperative day 1 fibrinogen synthesis was 5-6-fold higher than preoperatively and albumin synthesis 1.5-fold higher. On postoperative days 3-5 the synthesis levels decreased towards the preoperative levels.Conclusions: De novo synthesis of fibrinogen was markedly stimulated on postoperative day 1 after both hepatectomies and pancreatectomies, while albumin synthesis remained grossly unchanged. The less pronounced changes seen following hepatectomies were possibly related to the loss of liver tissue.