Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Colorectal Surgery Unit, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Unit of Occupational and Physical Therapy, Södersjukhuset, Stockholm, Sweden.
Clin Nutr ESPEN. 2021 Dec;46:330-335. doi: 10.1016/j.clnesp.2021.09.736. Epub 2021 Sep 29.
BACKGROUND & AIMS: Abnormal levels of hemoglobin, C-reactive protein (CRP) and albumin are common in people with gastrointestinal cancer. The hypothesis was that this is of importance for physical performance in older persons in the perioperative context. Thus, the aim was to evaluate the association between hemoglobin, CRP and albumin and physical performance before and after abdominal cancer surgery in older patients.
Patients ≥70 years of age scheduled for abdominal cancer surgery were invited to take part in the study. Data on levels of hemoglobin, CRP and albumin and physical performance (Six-Minute Walk Test, functional leg strength [chair-stands completed in 30 s], and maximal inspiratory muscle strength), were collected at baseline (n = 178) and physical performance was reassessed before discharge (n = 120). A composite score of 0-3 points was used, based on the presence or not of anemia, elevated CRP or hypoalbuminemia. Multivariable linear regressions were used for statistical analysis.
Before surgery, walking distance in patients scoring 2-3 (presence of 2 or 3 abnormal values) was shorter in comparison to patients scoring 0 (all values within normal range) in the multivariable model (-39.1 m; 95% CI -74.2, -3.9, p = 0.030). The number of chair stands performed during 30 s was lower in patients scoring 1 (-1.7; 95% CI -3.2, -0.2, p = 0.028) and 2-3 (-1.6; 95% CI -3.0, -0.1, p = 0.037) compared to patients scoring 0. No significant differences were seen between score groups and inspiratory muscle strength. After surgery, no differences were seen in walking distance or chair stands between patients with different scores.
Older patients with abnormal concentrations of hemoglobin, CRP and albumin before gastrointestinal cancer surgery showed impaired physical performance before surgery. Knowledge about potentially modifiable factors prior to cancer surgery increases the possibility to prepare the individual, which in turn might contribute to reduced morbidity and faster recovery after surgery.
胃肠道癌症患者的血红蛋白、C 反应蛋白（CRP）和白蛋白水平通常异常。研究假设这对围手术期老年患者的身体表现很重要。因此，本研究旨在评估血红蛋白、CRP 和白蛋白水平与老年腹部癌症手术后患者术前和术后身体表现之间的关系。
邀请年龄≥70 岁、计划接受腹部癌症手术的患者参加本研究。收集血红蛋白、CRP 和白蛋白水平以及身体表现（6 分钟步行测试、功能性腿部力量[30 秒内完成的椅子站立次数]和最大吸气肌肉力量）的数据，基线时（n=178）和出院前（n=120）进行评估。根据是否存在贫血、CRP 升高或低白蛋白血症，使用 0-3 分的复合评分。采用多变量线性回归进行统计分析。
手术前，在多变量模型中，评分 2-3 分（存在 2 或 3 个异常值）的患者与评分 0 分（所有值均在正常范围内）的患者相比，行走距离更短（相差 39.1 米；95%可信区间为-74.2 至-3.9，p=0.030）。在 30 秒内完成的椅子站立次数，评分 1 分（-1.7；95%可信区间-3.2 至-0.2，p=0.028）和 2-3 分（-1.6；95%可信区间-3.0 至-0.1，p=0.037）的患者明显低于评分 0 分的患者。评分组之间在吸气肌肉力量方面无显著差异。手术后，不同评分患者之间的行走距离或椅子站立次数无差异。
胃肠道癌症手术前血红蛋白、CRP 和白蛋白浓度异常的老年患者，术前身体表现受损。在癌症手术前了解潜在可改变的因素，可以增加对患者进行准备的可能性，从而可能降低术后发病率和加快康复速度。
