Perioperative Serum Albumin Level As Independent Predictor Of Surgical Outcome In Acute Abdomen

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Perioperative Serum Albumin Level As Independent Predictor Of Surgical Outcome In Acute Abdomen

Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2018, Vol 17, Issue 9

Abstract

Introduction: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. Hypoalbuminemia is a risk factor for mortality, postoperative complications, and prolonged hospital stay. The magnitude of the systemic inflammatory response during the perioperative period, as indicated by the acute-phase proteins-C-reactive protein (CRP) in particular,may help identify the risk of postoperative infectious complication. The correlation between serum albumin and CRP with gastrointestinal cancer has been reported. However, it is unclear whether antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period in colorectal surgery. The primary endpoint of this study was to reveal that antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period of colorectal surgery. Materials and methods: In this study, Medical records of 100 patients with estimated preoperative serum albumin level undergoing exploratory laparotomy with acute abdominal conditions in a tertiary health care centre were reviewed. Patients with record of preoperative serum albumin level were reviewed. Albumin less than 3.2 g/dL was recognized as hypoalbuminemia. Types of surgery, postoperative complications, and mortality rates were collected. The association between preoperative serum albumin level and postoperative morbidity and mortality was assessed. Results: Preoperative serum albumin level of 3.2g/dl was found in 33(30%) cases and 77(70%) patients had same or less than 3.2g/dl albumin. Patients with preoperative serum albumin less than 3.2 g/dL had complications in 50(45.5%) cases than that of normal preoperative albumin levels (07: 5.5%; p=<0.0001,95% CI=0.119-0.528).There was total mortality of 15(14%). High Mortality of 14(18%) patients was found in patients with low albumin group. There was 3% mortality with normal serum albumin level (P=<0.362; 95% CI=0.029-1.34). Skin and soft tissue infections were found in 5(15%) cases with albumin>3.2g/dl and 28 cases with less than 3.2g/dl (p=<0.397; 95%CI= 0.17-0.98).Chest infections were found in 2cases (6%) with >3.2g/dl serum albumin against 20 cases (25%) with less than 3.2g/dl. (p=0.0187; 95% CI=0.066-0.997). Conclusion: Serum albumin concentration is a better predictor of surgical outcomes than many other preoperative patient characteristics. It is a relatively low-cost test that should be used more frequently as a prognostic tool to detect malnutrition and risk of adverse surgical outcomes, particularly in populations in whom comorbid conditions are relatively frequent.

Authors and Affiliations

Dr. Deependu Kumar Sinha, Dr. Sujata Sahay

Keywords

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EP ID EP395424
DOI 10.9790/0853-1709087072.
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