Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery?
Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery?
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DOI：
10.1093/icvts/ivv247
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发表时间：
2015-12-01
影响因子：
--
通讯作者：
Dhital, Kumud
中科院分区：
文献类型：
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作者：
Karas, Pamela L.;Goh, Sean L.;Dhital, Kumud
最好的证据主题是根据结构化的方案编写的。研究的临床问题是：低血清白蛋白是否与心脏手术患者的术后并发症有关？使用报告的搜索策略检索到62篇论文。其中，12篇论文提供了回答这一临床问题的最佳证据。列出了论文的作者、期刊、发表日期和国家、调查的患者组、研究设计、相关结果和结果。本文共纳入12589例患者，其中4篇为3级，8篇为4级。每篇文献回顾并比较了所有或部分术后并发症：死亡率、术后再手术出血、住院时间延长和机械支持、感染、肝功能障碍、精神错乱和急性肾损伤(AKI)。在检查术后死亡率的研究中，除3项外，所有研究均与术前低白蛋白水平存在显著的多变量关联。在接受其他仅存在于单变量分析中的结果时，需要一些怀疑。虽然有三项研究检测了多种水平的血清白蛋白，但大多数研究将血清白蛋白水平分为正常组和异常组。这导致了不同类别的低蛋白血症，从低于2.5克/分升到4.0克/分升不等。然而，现有的证据表明，心脏手术患者的术前血清白蛋白水平低与以下因素有关：(1)术后死亡风险增加；(2)术后发病率增加。虽然有证据支持使用术前白蛋白来评估心脏手术后并发症，但从这篇综述中不能得出被认为是异常的特定白蛋白水平。
A best evidence topic was written according to a structured protocol. The clinical question investigated was: is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery? There were 62 papers retrieved using the reported search strategy. Of these, 12 publications embodied the best evidence to answer this clinical question. The authors, journal, date and country of the publication, patient group investigated, study design, relevant outcomes and results of these papers were tabulated. This paper includes a total of 12 589 patients, and of the papers reviewed, 4 were level 3 and 8 level 4. Each of the publications reviewed and compared either all or some of the following postoperative complications: mortality, postoperative bleeding requiring reoperation, prolonged hospital stay and ventilatory support, infection, liver dysfunction, delirium and acute kidney injury (AKI). Of the studies that examined postoperative mortality, all except for three established a significant multivariate association with low preoperative albumin level. Some scepticism is required in accepting other results that were only present in univariate analysis. While three studies examined multiple levels of serum albumin, most dichotomized the serum albumin levels into normal and abnormal groups. This led to differing classifications of hypoalbuminaemia, ranging from less than 2.5 to 4.0 g/dl. The available evidence, however, suggests that low preoperative serum albumin level in patients undergoing cardiac surgery is associated with the following: (i) increased risk of mortality after surgery and (ii) greater incidence of postoperative morbidity. While the evidence supports the use of preoperative albumin in assessing post-cardiac surgery complications, a specific level of albumin considered to be abnormal cannot be concluded from this review.