Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea.
J Cardiothorac Vasc Anesth. 2011 Jun;25(3):462-8. doi: 10.1053/j.jvca.2010.09.008. Epub 2010 Nov 19.
The authors aimed to investigate whether immediate postoperative hypoalbuminemia could be associated with outcomes after off-pump coronary artery bypass graft (OPCAB) surgery.
A retrospective analysis of the medical data.
Cardiac operating room and adult cardiovascular intensive care unit at a single institution.
Six hundred ninety adult patients underwent elective OPCAB surgery over a 30-month period.
None.
To evaluate the clinical relevance of immediate postoperative hypoalbuminemia, the lowest serum albumin level measured over the first 12 hours postoperatively was recorded. A cutoff point was calculated by the area under the curve in the receiver operating characteristic plot for 30-day adverse events including death. Patients were classified according to the cutoff value, and outcomes were compared between groups using propensity score-matching analysis. The impact of immediate postoperative hypoalbuminemia on OPCAB outcome was investigated using multivariate analysis. The cutoff value for immediate postoperative albumin concentration for predicting 30-day adverse events was 2.3 g/dL. Immediate postoperative hypoalbuminemia (<2.3 g/dL) was associated independently with postoperative respiratory failure (odds ratio [OR] = 8.85, p = 0.04), wound infection (OR = 4.44, p = 0.04), the need for an intra-aortic balloon pump after the operation (OR = 13.7, p = 0.02), renal failure (OR = 7.98, p = 0.01), reoperation for bleeding (OR = 4.33, p = 0.05), and the need for inotropes in the intensive care unit (OR = 1.79, p = 0.02).
Immediate postoperative hypoalbuminemia was associated with poorer outcomes in OPCAB patients. Monitoring of albumin levels after OPCAB could identify patients at risk for short-term adverse events.
作者旨在研究术后即刻低白蛋白血症是否与非体外循环冠状动脉旁路移植术（OPCAB）术后结局相关。
对医疗数据的回顾性分析。
单一机构的心脏手术室和成人心血管重症监护病房。
在 30 个月的时间内，690 名成年患者接受了择期 OPCAB 手术。
无。
为了评估术后即刻低白蛋白血症的临床相关性，记录术后 12 小时内测得的最低血清白蛋白水平。通过接受者操作特征曲线下面积计算切点值，用于预测 30 天不良事件，包括死亡。根据切点值对患者进行分类，并使用倾向评分匹配分析比较组间结果。使用多变量分析研究术后即刻低白蛋白血症对 OPCAB 结果的影响。术后即刻白蛋白浓度的切点值预测 30 天不良事件为 2.3 g/dL。术后即刻低白蛋白血症（<2.3 g/dL）与术后呼吸衰竭（比值比[OR] = 8.85，p = 0.04）、伤口感染（OR = 4.44，p = 0.04）、术后需要主动脉内球囊泵（OR = 13.7，p = 0.02）、肾衰竭（OR = 7.98，p = 0.01）、因出血再次手术（OR = 4.33，p = 0.05）和重症监护室需要正性肌力药物（OR = 1.79，p = 0.02）独立相关。
术后即刻低白蛋白血症与 OPCAB 患者的不良结局相关。OPCAB 后监测白蛋白水平可识别短期不良事件风险患者。
