Nutrition Support Team, Seoul National University Hospital, Seoul, South Korea.
J Gastrointest Surg. 2011 Dec;15(12):2136-44. doi: 10.1007/s11605-011-1719-z. Epub 2011 Oct 12.
BACKGROUND/OBJECTIVES: Preoperative nutritional status is associated with postoperative complications. Prealbumin, a visceral protein, is sensitive to protein malnutrition. The objective of this study is to evaluate the role of preoperative prealbumin levels as a marker for predicting complications after gastric surgery.
An observational study was performed on 183 patients who underwent gastric surgery due to benign or malignant gastric disease at Seoul National University Hospital (SNUH) between August 2009 and October 2010. Preoperative prealbumin levels were also measured. Nutritional variables such as prealbumin (cutoff value, 18 mg/dL), albumin, body mass index (BMI), and clinicopathologic data were collected. Postoperative hospital stay, 30-day complications and mortality rate were obtained to investigate outcomes.
The complication rate was 52% in the abnormal prealbumin group (n = 23) and 24% in the normal prealbumin group (n = 160; p = 0.005). The complication rate was higher in patients with low preoperative albumin levels (<3.5 g/dL) and abnormal BMI (<18.5 kg/m(2)), but the differences were not statistically significant. Comorbidity of diabetes mellitus (DM), resection extent, combined resection, TNM stage and prealbumin levels were associated with complications. In multivariate analysis, DM and combined resection were significantly correlated with complications (p = 0.001 for each). In subgroup analysis, resection extent, approach, combined resection, TNM stage, and prealbumin levels were significantly associated with infectious complications. Multivariate analysis identified combined resection (p = 0.001) and prealbumin levels (p = 0.032) as independent variables.
Preoperative prealbumin levels could be a useful marker for predicting complications, especially infectious complications, after gastric surgery.
背景/目的：术前营养状况与术后并发症相关。前白蛋白是一种内脏蛋白，对蛋白质营养不良敏感。本研究旨在评估术前前白蛋白水平作为预测胃手术后并发症的标志物的作用。
对 2009 年 8 月至 2010 年 10 月在首尔国立大学医院（SNUH）因良性或恶性胃部疾病接受胃手术的 183 名患者进行了一项观察性研究。还测量了术前前白蛋白水平。收集了营养变量，如前白蛋白（截断值，18mg/dL）、白蛋白、体重指数（BMI）和临床病理数据。调查了术后住院时间、30 天并发症和死亡率以评估结果。
异常前白蛋白组（n=23）的并发症发生率为 52%，正常前白蛋白组（n=160）的并发症发生率为 24%（p=0.005）。术前白蛋白水平低（<3.5g/dL）和 BMI 异常（<18.5kg/m²）的患者并发症发生率较高，但差异无统计学意义。糖尿病（DM）合并症、切除范围、联合切除、TNM 分期和前白蛋白水平与并发症相关。多变量分析显示，DM 和联合切除与并发症显著相关（p=0.001）。在亚组分析中，切除范围、方法、联合切除、TNM 分期和前白蛋白水平与感染性并发症显著相关。多变量分析确定联合切除（p=0.001）和前白蛋白水平（p=0.032）为独立变量。
术前前白蛋白水平可作为预测胃手术后并发症的有用标志物，尤其是感染性并发症。
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