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. 2016:2016:8743187.
doi: 10.1155/2016/8743187. Epub 2016 Jan 6.

Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study

Martin Hübner  1 , Styliani Mantziari  1 , Nicolas Demartines  1 , François Pralong  1 , Pauline Coti-Bertrand  1 , Markus Schäfer  1
Affiliations

Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study

Martin Hübner et al. Gastroenterol Res Pract. 2016.

Abstract

Background. Surgical stress during major surgery may be related to adverse clinical outcomes and early quantification of stress response would be useful to allow prompt interventions. The aim of this study was to evaluate the acute phase protein albumin in the context of the postoperative stress response. Methods. This prospective pilot study included 70 patients undergoing frequent abdominal procedures of different magnitude. Albumin (Alb) and C-reactive protein (CRP) levels were measured once daily starting the day before surgery until postoperative day (POD) 5. Maximal Alb decrease (Alb Δ min) was correlated with clinical parameters of surgical stress, postoperative complications, and length of stay. Results. Albumin values dropped immediately after surgery by about 10 g/L (42.2 ± 4.5 g/L preoperatively versus 33.8 ± 5.3 g/L at day 1, P < 0.001). Alb Δ min was correlated with operation length (Pearson ρ = 0.470, P < 0.001), estimated blood loss (ρ = 0.605, P < 0.001), and maximal CRP values (ρ = 0.391, P = 0.002). Alb Δ min levels were significantly higher in patients having complications (10.0 ± 5.4 versus 6.1 ± 5.2, P = 0.005) and a longer hospital stay (ρ = 0.285, P < 0.020). Conclusion. Early postoperative albumin drop appeared to reflect the magnitude of surgical trauma and was correlated with adverse clinical outcomes. Its promising role as early marker for stress response deserves further prospective evaluation.

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Figures

Figure 1
Figure 1
Acute inflammatory response after abdominal surgery as reflected by albumin and CRP kinetics. C-reactive protein (CRP) and albumin were measured preoperatively (pre-OP), 6 hours after surgery, and on postoperative days (POD) 1–5. CRP levels peaked (CRP Δ max) on POD 2 (a), while minimal albumin levels (Alb Δ min) were measured already 6 hours after surgery (b).
Figure 2
Figure 2
Correlation of postoperative CRP increase and albumin drop. Maximal C-reactive protein levels (CRP Δ max) are plotted against postoperative albumin drops (Alb Δ min).
Figure 3
Figure 3
CRP levels and Albumin drop after different major surgery procedures. Maximal C-reactive protein levels (CRP Δ max) for major colon, upper gastrointestinal, liver, and pancreatic resections (a) showing significant lower values for liver resections. Postoperative albumin decrease (Alb Δ min) was equally high for the four different types of surgery (b).
Figure 4
Figure 4
Correlation between albumin drop and operative time. Postoperative albumin decrease (Alb Δ min) is significantly correlated with operative time (Pearson ρ = 0.470, P < 0.001).
Figure 5
Figure 5
Albumin drop and hospital stay. Alb Δ min shows a positive correlation with increased length of hospital stay (Pearson ρ = 0.285,  P = 0.02).
See this image and copyright information in PMC

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