Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre.
Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre.
复制标题
血清白蛋白的术后减少是否是大腹部手术后并发症的早期预测指标？在欧洲中心进行的一项前瞻性队列研究。
DOI：
10.1136/bmjopen-2016-013966
复制
发表时间：
2017-04-08
期刊：
影响因子：
2.9
通讯作者：
Hübner M
中科院分区：
文献类型：
--
作者：
Labgaa I;Joliat GR;Kefleyesus A;Mantziari S;Schäfer M;Demartines N;Hübner M
探讨术后血清白蛋白下降（ΔAlb）作为手术应激反应的标志物和临床结局的早期预测指标。前瞻性队列研究（NCT 02356484）。对138例接受腹部大手术的患者进行了前瞻性白蛋白测定。在手术前和术后第0、1、2和3天收集血液样品。将ΔAlb与改良的生理能力和手术应激评估（mE-PASS）评分进行比较，并与C反应蛋白（CRP）、降钙素原（PCT）和乳酸（LCT）的性能相关。术后结局为根据Clavien分类和综合并发症指数（CCI）的术后并发症和住院时间（LoS）。欧洲三级中心腹部外科。接受择期腹部大手术的成人患者，预期持续时间≥2小时。 排除术前接受免疫抑制剂或抗生素治疗的患者。术后血清白蛋白水平迅速下降。ΔAlb与mE-PASS评分（r=0.275，p=0.01）和CRP升高（r=0.536，p<0.001）相关。ΔAlb还与总并发症（r=0.485，p<0.001）、CCI（r=0.383，p<0.001）和LoS（r=0.468，p<0.001）相关。ΔAlb ≥10 g/L预测并发症的敏感性为77.1%，特异性为67.2%（AUC：78.3%）。 术后第1天ΔAlb ≥10 g/L的患者显示总体术后并发症风险增加3倍。术后早期血清白蛋白的降低与手术范围、代谢反应和不良结局（如并发症和住院时间）相关。POD 1时血清白蛋白浓度降低≥10 g/L与总体术后并发症风险增加3倍相关，因此可用于识别风险患者。
To test postoperative serum albumin drop (ΔAlb) as a marker of surgical stress response and early predictor of clinical outcomes. Prospective 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). Department of abdominal surgery in a European tertiary centre. Adult patients undergoing elective major abdominal surgery, with anticipated duration ≥2 hours. Patients on immunosuppressive or antibiotic treatments before surgery were excluded. The 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. Early 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.
登录
查看更多内容
影响因子：
3.2
作者：
Ryan, Aoife M.;Hearty, Aine;Reynolds, John V.
通讯作者：
Reynolds, John V.
影响因子：
3.4
作者：
Amar, David;Zhang, Hao;Thaler, Howard T.
通讯作者：
Thaler, Howard T.
DOI：
10.1053/j.jvca.2010.09.008
发表时间：
2011-06-01
影响因子：
2.8
作者：
Lee, Eun-Ho;Chin, Ji-Hyun;Choi, In-Cheol
通讯作者：
Choi, In-Cheol
影响因子：
8.8
作者：
Noordzij, Peter G.;Poldermans, Don;Boersma, Eric
通讯作者：
Boersma, Eric
影响因子：
9
作者：
Facy, Olivier;Paquette, Brice;Ortega-Deballon, Pablo
通讯作者：
Ortega-Deballon, Pablo