Hypoalbuminemia and Long-Term Survival After Coronary Artery Bypass: A Propensity Score Analysis
Hypoalbuminemia and Long-Term Survival After Coronary Artery Bypass: A Propensity Score Analysis
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DOI：
10.1016/j.athoracsur.2010.09.004
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发表时间：
2011-03-01
影响因子：
4.6
通讯作者：
Chu, Danny
中科院分区：
文献类型：
--
作者：
de la Cruz, Kim I.;Bakaeen, Faisal G.;Chu, Danny
背景低白蛋白血症与手术患者发病率增加有关。低白蛋白水平对心脏手术患者生存率的影响尚不清楚。我们假设术前低白蛋白水平对冠状动脉旁路移植术（CABG）后的长期生存率有负面影响。我们回顾了1997年至2007年期间在我们机构接受直接孤立CABG的1，164例连续患者的记录。18个术前和术中变量的倾向评分分析平衡了两组患者之间的潜在混杂因素，因此最终研究队列包括588例患者：294例术前白蛋白水平低于3.5 g/dL（即低白蛋白血症），294例术前白蛋白水平≥ 3.5 g/dL。我们使用Kaplan-Meier曲线评估长期生存率。两组患者在术前和术中协变量方面匹配良好。两组的早期结局相似，包括30天死亡率（2.0% vs 1.7%; p = 0. 001）。76)和主要不良心脏事件的发生率（2.7%对2.7%; p = 1.0）。然而，低白蛋白血症患者的8年生存率显著低于无低白蛋白血症患者（65%+/-7% vs 86%+/-3%;风险比2.2; 95%可信区间：1.4 - 3.6; p = 0.001）。尽管术前低白蛋白血症并不能预测CABG患者术后早期死亡率或发病率的增加，但它确实能独立预测CABG术后的长期生存率。确定这种关系的机制对于改善接受手术心肌血运重建的低血清白蛋白水平患者的总生存率至关重要。
Background. Hypoalbuminemia is associated with increased morbidity in surgical patients. The impact of low albumin level on survival in cardiac surgical patients is unknown. We hypothesized that a low preoperative albumin level negatively affects long-term survival after coronary artery bypass graft (CABG) surgery.Methods. We reviewed prospectively gathered data from the records of 1,164 consecutive patients who underwent primary isolated CABG at our institution between 1997 and 2007. Propensity score analysis of 18 preoperative and intraoperative variables balanced potential confounding factors between the two groups of patients, so that the final study cohort consisted of 588 patients: 294 with a preoperative albumin level less than 3.5 g/dL (ie, hypoalbuminemia) and 294 patients with a preoperative albumin level of 3.5 g/dL or greater. We assessed long-term survival by using Kaplan-Meier curves generated by log rank tests.Results. The two groups of patients were well matched in terms of preoperative and intraoperative covariates. Both groups had similar early outcomes, including 30-day mortality rates (2.0% versus 1.7%; p = 0. 76) and the incidence of major adverse cardiac events (2.7% versus 2.7%; p = 1.0). However, patients with hypoalbuminemia had a significantly worse 8-year survival rate (65% +/- 7% versus 86% +/- 3%; hazard ratio 2.2; 95% confidence interval: 1.4 to 3.6; p = 0.001) than patients without hypoalbuminemia.Conclusions. Although preoperative hypoalbuminemia did not predict increased early postoperative mortality or morbidity in CABG patients, it did independently predict poor long-term survival after CABG. Identifying the mechanism that underlies this relationship is essential in improving overall survival among patients with low serum albumin levels who are undergoing surgical myocardial revascularization.