Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy
Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy
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DOI：
10.1007/s11605-007-0223-y
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发表时间：
2007-10-01
影响因子：
3.2
通讯作者：
Reynolds, John V.
中科院分区：
文献类型：
--
作者：
Ryan, Aoife M.;Hearty, Aine;Reynolds, John V.
目的血清白蛋白的变化可能反映创伤、脓毒症等损伤后机体的免疫炎症反应和高代谢。食管切除术与主要代谢应激有关，本研究的目的是确定术后第一天的绝对白蛋白水平是否具有预测院内并发症的价值。方法对1999年至2005年在圣詹姆斯医院因恶性疾病接受食管切除术的200例患者进行回顾性研究。测量了术前和术后（第1、3和7天）血清白蛋白水平的患者纳入研究。患者被细分为三个术后白蛋白类别< 20 g/ l、20 - 25 g/ l、> 25 g/ l。结果术后第1天白蛋白低于20 g/l的患者发生术后并发症的可能性是术后第1天白蛋白高于20 g/l的患者的2倍（分别为54%和28%，P< 0.011）。相应地，这些患者的成人呼吸窘迫综合征（22 vs 5%，p< 0.001）、呼吸衰竭（27 vs 8%，p< 0.01）和住院死亡率（27 vs 6%，p< 0.001）也显著较高。在多变量逻辑回归分析中，第1天白蛋白水平与术后并发症独立相关（优势比，0.89：95%;置信区间，0.83 - 0.96; p< 0.005）。此外，白蛋白< 20 g/ L的术后第一天与需要进一步手术，并返回ICU。结论血清白蛋白浓度在术后第一天是一个更好的预测手术结果比许多其他术前危险因素。这是一种低成本的测试，可用作预后工具，以检测不良手术结果的风险。
Objective Changes in serum albumin may reflect systemic immunoinflammation and hypermetabolism in response to insults such as trauma and sepsis. Esophagectomy is associated with a major metabolic stress, and the aim of this study was to determine if the absolute albumin level on the first postoperative day was of value in predicting in- hospital complications.Methods A retrospective study of 200 patients undergoing esophagectomy for malignant disease at St. James Hospital between 1999 and 2005 was performed. Patients who had pre and postoperative ( days 1, 3, and 7) serum albumin levels measured were included in the study. Patients were subdivided into three postoperative albumin categories < 20 g/ l, 20 - 25 g/ l, > 25 g/ l. Logistic regression analysis was performed to calculate the odds of morbidity and mortality according to the day 1 albumin level.Results Patients with an albumin of less than 20 g/ l on the first postoperative day were twice as likely to develop postoperative complications than those with an albumin of greater than 20 g/ l ( 54 vs 28% respectively, p< 0.011). Correspondingly, these patients also had a significantly higher rate of Adult Respiratory Distress Syndrome ( 22 vs 5%, p< 0.001), respiratory failure ( 27 vs 8%, p< 0.01) and in- hospital mortality ( 27 vs 6% ( p< 0.001). On multivariate logistic regression analysis, day 1 albumin level was independently related to postoperative complications ( odds ratios, 0.89: 95%; confidence intervals, 0.83 - 0.96; p< 0.005). In addition, albumin < 20 g/ l on the first postoperative day was associated with the need for further surgery and a return to ICU.Conclusion Serum albumin concentration on the first postoperative day is a better predictor of surgical outcome than many other preoperative risk factors. It is a low cost test that may be used as a prognostic tool to detect the risk of adverse surgical outcomes.