Fibrinogen and albumin synthesis rates in major upper abdominal surgery

Abstract

Plasma fibrinogen and albumin concentrations initially decrease after abdominal surgery. On postoperative days 3-5 fibrinogen concentration returns to the preoperative level or even higher, while albumin stays low. It is not known if these altered plasma concentrations reflect changes in synthesis rate, utilization, or both. In particular a low albumin plasma concentration has often been attributed to a low synthesis rate, which is not always the case. The objective of this study was to determine fibrinogen and albumin quantitative synthesis rates in patients undergoing major upper abdominal surgery with and without intact liver size. Patients undergoing liver or pancreatic resection (n = 9+6) were studied preoperatively, on postoperative days 1 and 3-5. De novo synthesis of fibrinogen and albumin was determined; in addition, several biomarkers indicative of fibrinogen utilization were monitored. After hemihepatectomy, fibrinogen synthesis was 2-3-fold higher on postoperative day 1 than preoperatively. On postoperative days 3-5 the synthesis level was still higher than preoperatively. Following major liver resections albumin synthesis was not altered postoperatively compared to preoperative values. After pancreatic resection, on postoperative day 1 fibrinogen synthesis was 5-6-fold higher than preoperatively and albumin synthesis 1.5-fold higher. On postoperative days 3-5, synthesis levels returned to preoperative levels. Despite decreases in plasma concentrations, de novo synthesis of fibrinogen was markedly stimulated on postoperative day 1 after both hemihepatectomies and pancreatectomies, while de novo albumin synthesis remained grossly unchanged. The less pronounced changes seen following hepatectomies were possibly related to the loss of liver tissue.

Fig 1

The fibrinogen plasma concentrations (A) and synthesis rates (B). The individual values for all patients undergoing liver surgery and pancreas surgery are depicted as black bold points. Levels of statistical significance for the ANOVA (or mixed-effects model analysis within groups) are given in the upper right corner. For multiple comparisons *, **, ***, **** denotes the statistical significance p < 0.05, p < 0.01, p<0.001 and < 0.0001 respectively of the difference from preoperative values, while # have the same significance from postoperative day 1.

Fig 2

The albumin plasma concentrations (A) and synthesis rates (B). The individual values for all patients undergoing liver surgery and pancreas surgery are depicted as black bold points. Levels of statistical significance for the ANOVA (or mixed-effects model analysis within groups) are given in the upper right corner. For multiple comparisons *, **, ***, **** denotes the statistical significance p < 0.05, p < 0.01, p<0.001 and < 0.0001 respectively of the difference from preoperative values, while # have the same significance from postoperative day 1.

Fig 3

The temporal pattern of fibrinogen and albumin plasma concentrations (A) and synthesis rates (B). Liver surgery is depicted in red and pancreas surgery in blue. Values are provided as the mean + 0.95 confidence intervals and the level of statistical significance for mixed-effects model analysis between groups is given in the upper right corner.