Division of Vascular Surgery, University of Missouri, Columbia, Mo.
Department of Family and Community Medicine, University of Missouri, Columbia, Mo.
J Vasc Surg. 2021 Jan;73(1):200-209. doi: 10.1016/j.jvs.2020.04.524. Epub 2020 May 26.
A low albumin level has been associated with poor outcome, including death, in surgical patients. The mechanistic relationship, however, is more complex than simply nutritional. As studies are scant in the vascular population, we sought to examine the association of low albumin level with outcomes in patients undergoing open and endovascular lower extremity procedures for peripheral artery disease.
Patients with peripheral artery disease undergoing lower extremity procedures (2008-2015) were selected from Cerner Health Facts database (Cerner Corporation, Kansas City, Mo) using International Classification of Diseases, Ninth Revision diagnosis and procedure codes. Age, sex, disease severity, and other comorbidities were captured. Outcomes were identified using codes and encounter data. A χanalysis and multivariable logistic regression were performed.
There were 6170 patients evaluated; 4562 (74%) underwent endovascular procedures and 1608 (26%) underwent open surgery. Low albumin level (<3.5 g/dL) was associated with age ≥80 years (23.1% vs 16.3% normal; P < .0001), black race (21% vs 11.6% normal; P < .0001), tissue loss (38% vs 16.4% normal; P < .0001), and higher Charlson index (mean, 3.1 vs 2.2 in the normal group; P < .0001). Low albumin level was also associated with longer length of stay (4.9 vs 2.2 days normal; P < .0001), higher in-hospital mortality (1.9% vs 0.3% normal; P < .0001), and higher 30-day readmission (15% vs 12.7% normal; P = .02). Multivariable analysis demonstrated that low albumin level was strongly associated with in-hospital death (odds ratio [OR], 5.23; 95% confidence interval [CI], 2.00-13.70), infection (OR, 2.51; 95% CI, 1.96-3.22), renal failure (OR, 2.61; 95% CI, 1.79-3.79), and cardiac complications (OR, 2.59; 95% CI, 1.69-3.96). After multivariable adjustment, there was no association between albumin level and 30-day readmission.
Low preoperative albumin levels are associated with in-hospital death, prolonged length of stay, and severe morbidity after open and endovascular lower extremity procedures. As the majority of lower extremity procedures are elective, serious consideration should be given to deferring elective procedures until albumin levels have been optimized. Because of the pleiotropic effects of albumin, including antiplatelet and inflammatory function, study of this complex relationship may offer insights into how best to integrate this novel biomarker into vascular surgery decision-making.
低白蛋白水平与手术患者的不良预后（包括死亡）有关。然而，其机制关系比单纯的营养更为复杂。由于血管人群的研究很少，我们试图研究低白蛋白水平与接受开放性和血管内下肢手术治疗外周动脉疾病的患者结局之间的关系。
使用国际疾病分类第 9 版诊断和手术代码从 Cerner Health Facts 数据库（堪萨斯城的 Cerner 公司）中选择了 2008-2015 年接受下肢手术的外周动脉疾病患者。年龄、性别、疾病严重程度和其他合并症均被记录。使用代码和就诊数据确定结局。进行了卡方检验和多变量逻辑回归分析。
共评估了 6170 例患者；其中 4562 例（74%）接受了血管内手术，1608 例（26%）接受了开放性手术。低白蛋白水平（<3.5g/dL）与年龄≥80 岁（23.1%比正常水平的 16.3%；P<0.0001）、黑种人（21%比正常水平的 11.6%；P<0.0001）、组织损失（38%比正常水平的 16.4%；P<0.0001）和更高的 Charlson 指数（平均值，3.1 比正常组的 2.2；P<0.0001）相关。低白蛋白水平也与更长的住院时间（4.9 天比正常水平的 2.2 天；P<0.0001）、更高的院内死亡率（1.9%比正常水平的 0.3%；P<0.0001）和更高的 30 天再入院率（15%比正常水平的 12.7%；P=0.02）相关。多变量分析表明，低白蛋白水平与院内死亡（比值比[OR]，5.23；95%置信区间[CI]，2.00-13.70）、感染（OR，2.51；95%CI，1.96-3.22）、肾衰竭（OR，2.61；95%CI，1.79-3.79）和心脏并发症（OR，2.59；95%CI，1.69-3.96）密切相关。在多变量调整后，白蛋白水平与 30 天再入院之间无关联。
术前低白蛋白水平与开放性和血管内下肢手术后的院内死亡、住院时间延长和严重并发症相关。由于大多数下肢手术是择期进行的，因此应认真考虑将择期手术推迟到白蛋白水平得到优化。由于白蛋白具有抗血小板和抗炎等多种作用，因此研究这种复杂的关系可能有助于了解如何将这种新型生物标志物更好地纳入血管外科学的决策中。
