Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria.
PLoS One. 2018 Nov 13;13(11):e0206911. doi: 10.1371/journal.pone.0206911. eCollection 2018.
Little is known about the perioperative dynamic of albumin and its effect on surgical outcome in Crohn's disease. Thus, we aimed to assess postoperative changes of albumin levels and their potentially predictive role for complications after laparoscopic intestinal resections.
We identified 182 patients who underwent laparoscopic intestinal resection for symptomatic Crohn´s disease between 2000 and 2014 for this retrospective cohort study. Pre- and postoperative serum albumin levels (within 4 days) were recorded retrospectively and proportional postoperative reduction (delta (Δ) albumin) was calculated. Complications were defined according to the Clavien-Dindo classification. Univariate and multivariate analysis describing an eventful postoperative course were conducted.
Complications were found in 22.5% (n = 41), 6% (n = 11) developed major complications defined as Clavien Dindo III-V and 16.5% (n = 30) had minor complications (Clavien Dindo I-II). The median Δ albumin was 22.75% (range: -18.46-47.14%). Delta albumin was found to be significantly higher in patients who developed complications after surgery (p = 0.03). Notably, neither preoperative (p = 0.28) nor postoperative albumin levels (p = 0.41) taken as absolute numerical values correlated with an eventful course following intestinal resection. In the multivariate analysis, based on a cut-off of 24.27%, Δ albumin remained an independent factor for surgical complications (p = 0.04, OR 2.232) next to conversion rate (p<0.001, OR 5.577) and the presence of an inflammatory mass (p = 0.003, OR 0.280).
Δ albumin is a better prognostic marker for an eventful postoperative course after laparoscopic surgery in patients with Crohn's disease in comparison to albumin alone.
关于白蛋白的围手术期动态及其对克罗恩病手术结果的影响知之甚少。因此，我们旨在评估术后白蛋白水平的变化及其对腹腔镜肠切除术并发症的潜在预测作用。
我们回顾性地分析了 2000 年至 2014 年间因症状性克罗恩病接受腹腔镜肠切除术的 182 例患者，记录了术前和术后 4 天内的血清白蛋白水平（术后白蛋白水平），并计算了术后白蛋白的比例降低（白蛋白降低值（Δ））。并发症根据 Clavien-Dindo 分类定义。进行了单变量和多变量分析，以描述术后有事件发生的过程。
22.5%（n=41）的患者出现并发症，6%（n=11）发生严重并发症（Clavien Dindo III-V），16.5%（n=30）发生轻微并发症（Clavien Dindo I-II）。白蛋白降低值的中位数为 22.75%（范围：-18.46-47.14%）。术后发生并发症的患者白蛋白降低值显著更高（p=0.03）。值得注意的是，无论是术前（p=0.28）还是术后白蛋白水平（p=0.41）绝对值均与肠切除术后的不良病程无相关性。在多变量分析中，基于 24.27%的截断值，白蛋白降低值仍然是手术并发症的独立因素（p=0.04，OR 2.232），其次是转化率（p<0.001，OR 5.577）和炎症肿块的存在（p=0.003，OR 0.280）。
与单独白蛋白相比，白蛋白降低值是克罗恩病患者腹腔镜手术后不良术后病程的更好预后标志物。
