Petch-In Porapong, Saokaew Surasak, Phisalprapa Pochamana, Dilokthornsakul Piyameth
Pharmacy Department, Rayong Hospital, Rayong, Thailand.
Division of Social and Administrative Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
Drugs Real World Outcomes. 2023 Jun;10(2):341-349. doi: 10.1007/s40801-023-00364-4. Epub 2023 Mar 27.
Pre-operative hypoalbuminemia is known to predict negative outcomes for patients undergoing major surgeries. However, various cut-off points for starting exogenous albumin have been recommended.
This study investigated the association between pre-operative severe hypoalbuminemia, in-hospital death, and length of hospital stay in patients undergoing gastrointestinal surgery.
A retrospective cohort study using a database analysis was undertaken on hospitalized patients who underwent major gastrointestinal surgery. The pre-operative serum albumin level was classified into three groups: severe hypoalbuminemia (< 2.0 mg/dL) and non-severe hypoalbuminemia (≥ 2.0-3.4 g/dL) and normal level (3.5-5.5 g/dL). To compare between different cut-offs, a sensitivity analysis using another albumin level classification as severe hypoalbuminemia (< 2.5 mg/dL) and non-severe hypoalbuminemia (≥ 2.5-3.4 g/dL) and normal level (3.5-5.5 g/dL) was applied. The primary outcome was post-operative in-hospital death. Propensity-score adjusted regression analyses were applied.
A total of 670 patients were included. Their average age was 57.4 ± 16.3 years, and 56.1% were men. Only 59 patients (8.8%) had severe hypoalbuminemia. Overall, a total of 93 in-hospital deaths (13.9%) occurred among all included patients, but there were 24/59 (40.7%) deaths among patients with severe hypoalbuminemia, 59/302 (19.5%) deaths among patients with non-severe hypoalbuminemia, and 10/309 (3.2%) deaths among patients with normal albumin level. The adjusted odds ratio for post-operative in-hospital death comparing patients with severe hypoalbuminemia and patients with normal albumin level was 8.11 (3.31-19.87; p < 0.001), while the odds ratio for in-hospital death comparing patients with non-severe and patients with normal albumin level was 3.89 (1.87-8.10; p < 0.001). A sensitivity analysis showed similar findings, the odds ratio for in-hospital death for severe hypoalbuminemia (cut-off as < 2.5 g/dL) was 7.44 (3.38-16.36; p < 0.001), while the odds ratio for in-hospital death for severe hypoalbuminemia (cut-off as 2.5-3.4 g/dL) was 3.02 (1.40-6.52; p = 0.005).
Severe pre-operative hypoalbuminemia in patients undergoing gastrointestinal surgery was associated with an increased risk of in-hospital mortality. The risk of death for patients with severe hypoalbuminemia was relatively similar when using different cut-offs such as < 2.0 and <2.5 g/dL.
术前低白蛋白血症已知可预测接受大手术患者的不良结局。然而，对于开始使用外源性白蛋白的各种临界值已有推荐。
本研究调查了接受胃肠手术患者术前严重低白蛋白血症、院内死亡和住院时间之间的关联。
采用数据库分析进行一项回顾性队列研究，研究对象为接受大胃肠手术的住院患者。术前血清白蛋白水平分为三组：严重低白蛋白血症（<2.0mg/dL）、非严重低白蛋白血症（≥2.0 - 3.4g/dL）和正常水平（3.5 - 5.5g/dL）。为比较不同临界值，应用了敏感性分析，将白蛋白水平分类为严重低白蛋白血症（<2.5mg/dL）、非严重低白蛋白血症（≥2.5 - 3.4g/dL）和正常水平（3.5 - 5.5g/dL）。主要结局为术后院内死亡。应用倾向得分调整回归分析。
共纳入670例患者。他们的平均年龄为57.4±16.3岁，56.1%为男性。仅59例患者（8.8%）有严重低白蛋白血症。总体而言，所有纳入患者中共有93例院内死亡（13.9%），但严重低白蛋白血症患者中有24/59例（40.7%）死亡，非严重低白蛋白血症患者中有59/302例（19.5%）死亡，白蛋白水平正常的患者中有10/309例（3.2%）死亡。比较严重低白蛋白血症患者和白蛋白水平正常患者术后院内死亡的调整优势比为8.11（3.31 - 19.87；p<０.001），而比较非严重低白蛋白血症患者和白蛋白水平正常患者院内死亡的优势比为3.89（1.87 - 8.10；p<０.001）。敏感性分析显示了类似结果，严重低白蛋白血症（临界值<2.5g/dL）的院内死亡优势比为7.44（3.38 - 16.36；p<０.001），严重低白蛋白血症（临界值2.5 - 3.4g/dL）的院内死亡优势比为3.02（1.40 - 6.52；p = 0.005）。
接受胃肠手术患者术前严重低白蛋白血症与院内死亡风险增加相关。使用不同临界值如<2.0g/dL和<2.5g/dL时，严重低白蛋白血症患者的死亡风险相对相似。
