Huang Suiqing, Zhou Zhuoming, Luo Li, Yue Yuan, Liu Quan, Feng Kangni, Hou Jian, Wang Keke, Chen Jiantao, Li Huayang, Huang Lin, Fu Guangguo, Chen Guangxian, Liang Mengya, Wu Zhongkai
Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
Ann Transl Med. 2021 Sep;9(18):1445. doi: 10.21037/atm-21-3913.
Despite novel improvements in the diagnosis and treatment of infective endocarditis (IE), there has been no significant improvement in the survival rate of IE, which indicates that many details still need to be optimized in the preoperative assessment. We sought to evaluate preoperative serum albumin as a biomarker for predicting early mortality after IE surgery.
Between October 2013 and June 2019, patients with a definite diagnosis of IE were enrolled in this study. Patients' albumin levels at admission were used as the preoperative albumin levels. Restricted cubic spline and multivariate logistic regression analyses were performed to evaluate the relationship between albumin and early mortality. Receiver operating characteristic curve analyses were performed to assess the role of albumin in predicting early mortality and compare the predictive capacity of traditional models with models that included albumin.
Of the 276 IE patients, 20 (7.2%) died in hospital or within 30 days of surgery. Hypoalbuminemia (an albumin level <3.5 g/dL) was present in 109 (39.5%) patients. The multivariate logistic regression analysis showed that preoperative albumin was inversely associated with early mortality [adjusted odds ratio (OR) =0.22 per 1 g/dL, 95% confidence interval (CI): 0.07-0.65, P=0.006] after full adjustment. Preoperative albumin had value in predicting early mortality [area under the curve (AUC) =0.72, 95% CI: 0.61-0.84; P<0.01]. After adding albumin to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Charlson score, the predictive ability of the model was further improved (EuroSCORE II: AUC =0.55; 95% CI: 0.42-0.67 to AUC =0.72; 95% CI: 0.61-0.84; Charlson score: AUC =0.73; 95% CI: 0.64-0.83 to AUC =0.78; 95% CI: 0.68-0.88).
Preoperative serum albumin is inversely associated with early mortality after IE surgery, and is a promising prognostic indicator in preoperative risk stratification assessments of IE patients.
尽管感染性心内膜炎（IE）的诊断和治疗有了新的进展，但IE的生存率并未显著提高，这表明术前评估的许多细节仍需优化。我们试图评估术前血清白蛋白作为预测IE手术后早期死亡率的生物标志物。
2013年10月至2019年6月，确诊为IE的患者纳入本研究。患者入院时的白蛋白水平用作术前白蛋白水平。进行受限立方样条和多因素逻辑回归分析，以评估白蛋白与早期死亡率之间的关系。进行受试者工作特征曲线分析，以评估白蛋白在预测早期死亡率中的作用，并比较传统模型与包含白蛋白的模型的预测能力。
276例IE患者中，20例（7.2%）在住院期间或手术后30天内死亡。109例（39.5%）患者存在低白蛋白血症（白蛋白水平<3.5 g/dL）。多因素逻辑回归分析显示，完全调整后，术前白蛋白与早期死亡率呈负相关[调整后的比值比（OR）=每1 g/dL为0.22，95%置信区间（CI）：0.07-0.65，P=0.006]。术前白蛋白在预测早期死亡率方面有价值[曲线下面积（AUC）=0.72，95%CI：0.61-0.84；P<0.01]。将白蛋白添加到欧洲心脏手术风险评估系统（EuroSCORE）和查尔森评分中后，模型的预测能力进一步提高（EuroSCORE II：AUC =0.55；95%CI：0.42-0.67至AUC =0.72；95%CI：0.61-0.84；查尔森评分：AUC =0.73；95%CI：0.64-0.83至AUC =0.78；95%CI：0.68-0.88）。
术前血清白蛋白与IE手术后的早期死亡率呈负相关，是IE患者术前风险分层评估中有前景的预后指标。
