Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
World J Surg. 2023 Dec;47(12):3382-3393. doi: 10.1007/s00268-023-07178-z. Epub 2023 Sep 20.
Perioperative hypoalbuminemia has a prognostic effect on mortality and morbidity in various cohorts. Patients undergoing open repair of ruptured abdominal aortic aneurysms (rAAA) are at a high risk of hypoalbuminemia due to bleeding and underlying diseases. Hence, this study aimed to investigate the predictive value of immediate postoperative hypoalbuminemia for the risk for acute kidney injury (AKI) in patients undergoing open rAAA repair.
We retrospectively reviewed 143 patients who underwent open rAAA repair between January 2008 and May 2022. The patients were divided into two groups according to the presence of postoperative AKI. The perioperative serum albumin levels of the two groups were compared. The patients were further divided into two groups based on the median immediate postoperative albumin level (2.4 g/dL). The incidence of AKI was compared between the two groups. Multivariate logistic regression analysis was performed to assess the predictors of postoperative AKI. Kaplan-Meier survival curves were used to evaluate potential of AKI and albumin level as prognostic factors for mortality.
Immediate postoperative serum albumin was significantly lower in the AKI group than in the non-AKI group (2.11 ± 0.62 g/dL vs. 2.59 ± 0.62 g/dL, p < 0.001). The incidence of postoperative AKI was significantly higher in patients with albumin ≤ 2.4 g/dL than in patients with albumin > 2.4 g/dL (53.8% vs. 27.7%, p = 0.002). Immediate postoperative albumin level was an independent predictor of AKI (Odds ratio [OR], 0.310; 95% confidence interval [CI] 0.165-0.583, p < 0.001) and 1-year mortality (OR, 0.230; 95% CI 0.098-0.542, p = 0.001).
Immediate postoperative hypoalbuminemia was associated with postoperative AKI and mortality in patients with rAAA.
围手术期低白蛋白血症对各种队列的死亡率和发病率具有预后作用。由于出血和基础疾病，接受开放性腹主动脉瘤破裂（rAAA）修复的患者有发生低白蛋白血症的高风险。因此，本研究旨在探讨术后即刻低白蛋白血症对开放性 rAAA 修复患者发生急性肾损伤（AKI）风险的预测价值。
我们回顾性分析了 2008 年 1 月至 2022 年 5 月期间接受开放性 rAAA 修复的 143 名患者。根据术后 AKI 的存在将患者分为两组。比较两组患者的围手术期血清白蛋白水平。根据术后即刻白蛋白中位数（2.4 g/dL）将患者进一步分为两组。比较两组 AKI 的发生率。采用多变量逻辑回归分析评估术后 AKI 的预测因素。采用 Kaplan-Meier 生存曲线评估 AKI 和白蛋白水平作为死亡率的预后因素的潜力。
AKI 组患者术后即刻血清白蛋白明显低于非 AKI 组（2.11 ± 0.62 g/dL 比 2.59 ± 0.62 g/dL，p < 0.001）。白蛋白水平≤2.4 g/dL 的患者术后 AKI 的发生率明显高于白蛋白水平>2.4 g/dL 的患者（53.8%比 27.7%，p = 0.002）。术后即刻白蛋白水平是 AKI 的独立预测因子（优势比 [OR]，0.310；95%置信区间 [CI]，0.165-0.583，p < 0.001）和 1 年死亡率（OR，0.230；95%CI，0.098-0.542，p = 0.001）。
rAAA 患者术后即刻低白蛋白血症与术后 AKI 和死亡率相关。
