血清白蛋白的相对下降有助于预测女性保肛直肠手术后吻合口漏。
Relative decline in serum albumin help to predict anastomotic leakage for female patients following sphincter-preserving rectal surgery.
机构信息
Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
Third Division Hospital, Xinjiang Production and Construction Corps, Xinjiang, China.
出版信息
BMC Surg. 2023 Feb 19;23(1):38. doi: 10.1186/s12893-023-01923-w.
BACKGROUND
Patients with normal preoperative serum albumin still suffer from a significant reduction in serum albumin after major abdominal surgery. The current study aims to explore the predictive value of ∆ALB for AL in patients with normal serum albumin and examine whether there is a gender difference in the prediction of AL.
METHODS
Medical reports of consecutive patients undergoing elective sphincter-preserving rectal surgery between July 2010 and June 2016 were reviewed. Receiver operating characteristic (ROC) analysis was adopted to examine the predictive ability of ∆ALB and determine the cut-off value according to the Youden index. The logistic regression model was performed identify independent risk factors for AL.
RESULTS
Out of the 499 eligible patients, 40 experienced AL. Results of the ROC analyses showed that ΔALB displayed a significant predictive value for females, and the AUC value was 0.675 (P = 0.024), with a sensitivity of 93%. In male patients, the AUC was 0.575 (P = 0.22), but did not reach a significant level. In the multivariate analysis, ∆ALB ≥ 27.2% and low tumor location prove to be independent risk factors for AL in female patients.
CONCLUSIONS
The current study suggested that there may be a gender difference in the prediction of AL and ∆ ALB can serve as a potential predictive biomarker for AL in females. A cut-off value of the relative decline in serum albumin can help predict AL in female patients as early as postoperative day 2. Although our study needs further external validation, our findings may provide an earlier, easier and cheaper biomarker for the detection of AL.
背景
术前血清白蛋白正常的患者在接受大腹部手术后仍会出现显著的血清白蛋白降低。本研究旨在探讨 ∆ALB 对血清白蛋白正常患者 AL 的预测价值，并检验在 AL 的预测中是否存在性别差异。
方法
回顾性分析 2010 年 7 月至 2016 年 6 月间连续接受选择性保留肛门直肠手术的患者的病历。采用受试者工作特征（ROC）分析来检验 ∆ALB 的预测能力，并根据约登指数确定截断值。采用逻辑回归模型来确定 AL 的独立危险因素。
结果
在 499 例符合条件的患者中，有 40 例发生了 AL。ROC 分析结果表明，∆ALB 对女性具有显著的预测价值，AUC 值为 0.675（P=0.024），敏感度为 93%。在男性患者中，AUC 值为 0.575（P=0.22），但未达到显著水平。多因素分析显示，∆ALB≥27.2%和肿瘤位置较低是女性 AL 的独立危险因素。
结论
本研究提示，AL 的预测可能存在性别差异，∆ALB 可能是女性 AL 的潜在预测生物标志物。血清白蛋白相对下降的截断值有助于在术后第 2 天预测女性 AL。尽管我们的研究需要进一步的外部验证，但我们的研究结果可能为 AL 的检测提供更早、更简便和更经济的生物标志物。
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