Postoperative decrease of albumin (ΔAlb) as early predictor of complications after gastrointestinal surgery: a systematic review

doi:10.1186/s13741-022-00238-3

Review

. 2022 Feb 15;11(1):7.

doi: 10.1186/s13741-022-00238-3.

Postoperative decrease of albumin (ΔAlb) as early predictor of complications after gastrointestinal surgery: a systematic review

Gaëtan-Romain Joliat^{1

2}, Arnaud Schoor³, Markus Schäfer⁴, Nicolas Demartines⁴, Martin Hübner⁴, Ismail Labgaa⁴

Affiliations

¹ Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. gaetan.joliat@gmail.com.
² Graduate School of Health Sciences, University of Bern, Bern, Switzerland. gaetan.joliat@gmail.com.
³ Department of General and Visceral Surgery, HIB Hospital, Payerne, Switzerland.
⁴ Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.

PMID: 35164873
PMCID: PMC8845214
DOI: 10.1186/s13741-022-00238-3

Review

Postoperative decrease of albumin (ΔAlb) as early predictor of complications after gastrointestinal surgery: a systematic review

Gaëtan-Romain Joliat et al. Perioper Med (Lond). 2022.

. 2022 Feb 15;11(1):7.

doi: 10.1186/s13741-022-00238-3.

Authors

Gaëtan-Romain Joliat^{1

2}, Arnaud Schoor³, Markus Schäfer⁴, Nicolas Demartines⁴, Martin Hübner⁴, Ismail Labgaa⁴

Affiliations

¹ Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. gaetan.joliat@gmail.com.
² Graduate School of Health Sciences, University of Bern, Bern, Switzerland. gaetan.joliat@gmail.com.
³ Department of General and Visceral Surgery, HIB Hospital, Payerne, Switzerland.
⁴ Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.

PMID: 35164873
PMCID: PMC8845214
DOI: 10.1186/s13741-022-00238-3

Abstract

Background: Postoperative complications are frequent after gastrointestinal surgery and early prediction remains an unmet need. Serum albumin shows a rapid decrease after surgery, and this decline (ΔAlb) may reflect the intensity of the surgical stress response and thereby be a predictor of postoperative complications. This study aimed to comprehensively review the available data on ΔAlb in gastrointestinal surgery.

Methods: PRISMA guidelines were followed to conduct a systematic review of the literature in MEDLINE and Embase. Studies assessing the role of ΔAlb to predict complications after gastrointestinal surgery were included.

Results: A total of 1256 articles were screened, and 16 studies were included in the final analysis: 7 prospective and 9 retrospective trials. Sensitivity of ΔAlb to predict postoperative complications ranged from 63 to 84%, whereas specificity ranged from 61 to 86%. Nine out of the 16 included studies established a threshold of ΔAlb to predict morbidity (range: 5-11 g/l or 14-27%).

Conclusion: ΔAlb appeared as a valuable and promising biomarker to anticipate complications after gastrointestinal surgery. Future efforts are needed to determine whether and how ΔAlb may be integrated in clinical practice to guide clinicians in the perioperative management of patients.

Keywords: Biomarkers; Complications; Predictor; ΔAlb.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Flowchart of the study according to PRISMA

**Fig. 2**
Summary plot of receiver operating characteristic (ROC) curves for ΔAlb

**Fig. 3**
Visual summary of ΔAlb and other biomarkers and their relationship with extent of surgery and outcomes

See this image and copyright information in PMC

Cited by

A systematic review of predictive accuracy via c-statistic of preoperative frailty tests for extended length of stay, post-operative complications, and mortality.
Dunlop RAN, Van Zundert A. Dunlop RAN, et al. Saudi J Anaesth. 2023 Oct-Dec;17(4):575-580. doi: 10.4103/sja.sja_358_23. Epub 2023 Aug 18. Saudi J Anaesth. 2023. PMID: 37779562 Free PMC article. Review.
Neutrophil-albumin ratio as a biomarker for postoperative complications and long-term prognosis in patients with colorectal cancer undergoing surgical treatment.
Xie H, Wei L, Liu M, Liang Y, Yuan G, Gao S, Wang Q, Lin X, Tang S, Gan J. Xie H, et al. Front Nutr. 2022 Nov 15;9:976216. doi: 10.3389/fnut.2022.976216. eCollection 2022. Front Nutr. 2022. PMID: 36458178 Free PMC article.
Correlation Between Postoperative Complications and Serum Albumin Levels in Abdominal Surgery: A Prospective Observational Study.
Kumar S, Baitha KS, Dev A, Prakash P, Gunjan G. Kumar S, et al. Cureus. 2025 Jun 21;17(6):e86508. doi: 10.7759/cureus.86508. eCollection 2025 Jun. Cureus. 2025. PMID: 40698225 Free PMC article.
Serum concentrations of proinflammatory biomarker interleukin-6 (IL-6) as a predictor of postoperative complications after elective colorectal surgery.
Procházka V, Lacina L, Smetana K Jr, Svoboda M, Skřivanová K, Beňovská M, Jarkovský J, Křen L, Kala Z. Procházka V, et al. World J Surg Oncol. 2023 Dec 14;21(1):384. doi: 10.1186/s12957-023-03270-9. World J Surg Oncol. 2023. PMID: 38098074 Free PMC article.
Assessment of the Predictive Value of Preoperative Serum Albumin and Postoperative Albumin Drop (ΔAlb) for Complications after Pancreas Surgery: A Single-Center Cross-Sectional Study.
Gaspar-Figueiredo S, Labgaa I, Demartines N, Schäfer M, Joliat GR. Gaspar-Figueiredo S, et al. J Clin Med. 2023 Jan 27;12(3):972. doi: 10.3390/jcm12030972. J Clin Med. 2023. PMID: 36769619 Free PMC article.

See all "Cited by" articles

References

1. Ai S, Sun F, Liu Z, Yang Z, Wang J, Zhu Z, du S, Guan W. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ J Surg. 2019;89(7–8):E297–E301. doi: 10.1111/ans.15363. - DOI - PubMed
1. Fan ST, Lau WY, Wong KK, Chan YP. Pre-operative parenteral nutrition in patients with oesophageal cancer: a prospective, randomised clinical trial. Clin Nutr. 1989;8(1):23–27. doi: 10.1016/0261-5614(89)90021-6. - DOI - PubMed
1. Galata C, Busse L, Birgin E, Weiß C, Hardt J, Reißfelder C, Otto M. Role of Albumin as a Nutritional and Prognostic Marker in Elective Intestinal Surgery. Can J Gastroenterol Hepatol. 2020;2020:7028216–7028218. doi: 10.1155/2020/7028216. - DOI - PMC - PubMed
1. Ge X, Dai X, Ding C, Tian H, Yang J, Gong J, Zhu W, Li N, Li J. Early Postoperative Decrease of Serum Albumin Predicts Surgical Outcome in Patients Undergoing Colorectal Resection. Dis Colon Rectum. 2017;60(3):326–334. doi: 10.1097/DCR.0000000000000750. - DOI - PubMed
1. Giovannini I, Chiarla C, Giuliante F, Vellone M, Ardito F, Nuzzo G. The relationship between albumin, other plasma proteins and variables, and age in the acute phase response after liver resection in man. Amino Acids. 2006;31(4):463–469. doi: 10.1007/s00726-005-0287-5. - DOI - PubMed

Publication types

Actions

LinkOut - more resources

Full Text Sources

[1] Ai S, Sun F, Liu Z, Yang Z, Wang J, Zhu Z, du S, Guan W. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ J Surg. 2019;89(7–8):E297–E301. doi: 10.1111/ans.15363. - DOI - PubMed

[2] Ai S, Sun F, Liu Z, Yang Z, Wang J, Zhu Z, du S, Guan W. Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. ANZ J Surg. 2019;89(7–8):E297–E301. doi: 10.1111/ans.15363. - DOI - PubMed

[3] Fan ST, Lau WY, Wong KK, Chan YP. Pre-operative parenteral nutrition in patients with oesophageal cancer: a prospective, randomised clinical trial. Clin Nutr. 1989;8(1):23–27. doi: 10.1016/0261-5614(89)90021-6. - DOI - PubMed

[4] Fan ST, Lau WY, Wong KK, Chan YP. Pre-operative parenteral nutrition in patients with oesophageal cancer: a prospective, randomised clinical trial. Clin Nutr. 1989;8(1):23–27. doi: 10.1016/0261-5614(89)90021-6. - DOI - PubMed

[5] Galata C, Busse L, Birgin E, Weiß C, Hardt J, Reißfelder C, Otto M. Role of Albumin as a Nutritional and Prognostic Marker in Elective Intestinal Surgery. Can J Gastroenterol Hepatol. 2020;2020:7028216–7028218. doi: 10.1155/2020/7028216. - DOI - PMC - PubMed

[6] Galata C, Busse L, Birgin E, Weiß C, Hardt J, Reißfelder C, Otto M. Role of Albumin as a Nutritional and Prognostic Marker in Elective Intestinal Surgery. Can J Gastroenterol Hepatol. 2020;2020:7028216–7028218. doi: 10.1155/2020/7028216. - DOI - PMC - PubMed

[7] Ge X, Dai X, Ding C, Tian H, Yang J, Gong J, Zhu W, Li N, Li J. Early Postoperative Decrease of Serum Albumin Predicts Surgical Outcome in Patients Undergoing Colorectal Resection. Dis Colon Rectum. 2017;60(3):326–334. doi: 10.1097/DCR.0000000000000750. - DOI - PubMed

[8] Ge X, Dai X, Ding C, Tian H, Yang J, Gong J, Zhu W, Li N, Li J. Early Postoperative Decrease of Serum Albumin Predicts Surgical Outcome in Patients Undergoing Colorectal Resection. Dis Colon Rectum. 2017;60(3):326–334. doi: 10.1097/DCR.0000000000000750. - DOI - PubMed

[9] Giovannini I, Chiarla C, Giuliante F, Vellone M, Ardito F, Nuzzo G. The relationship between albumin, other plasma proteins and variables, and age in the acute phase response after liver resection in man. Amino Acids. 2006;31(4):463–469. doi: 10.1007/s00726-005-0287-5. - DOI - PubMed

[10] Giovannini I, Chiarla C, Giuliante F, Vellone M, Ardito F, Nuzzo G. The relationship between albumin, other plasma proteins and variables, and age in the acute phase response after liver resection in man. Amino Acids. 2006;31(4):463–469. doi: 10.1007/s00726-005-0287-5. - DOI - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Postoperative decrease of albumin (ΔAlb) as early predictor of complications after gastrointestinal surgery: a systematic review

Affiliations

Postoperative decrease of albumin (ΔAlb) as early predictor of complications after gastrointestinal surgery: a systematic review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

LinkOut - more resources

Full Text Sources