Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States.
Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States.
J Gastrointest Surg. 2024 Jun;28(6):843-851. doi: 10.1016/j.gassur.2024.03.012. Epub 2024 Mar 24.
Patients with liver disease undergoing colectomy have higher rates of complications and mortality. The Albumin-Bilirubin score is a recently developed system, established to predict outcomes after hepatectomy, that accounts for liver dysfunction.
All patients undergoing colectomy were identified in the 2015-2018 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database. Demographics and outcomes were compared between patients with Albumin-Bilirubin Grade 1 vs. 2/3. Multivariable regression was performed for outcomes including colorectal-specific complications. Areas under the receiver operative characteristic curves were calculated to determine accuracy of the Albumin-Bilirubin score.
Of 86,273 patients identified, 48% (N = 41,624) were Albumin-Bilirubin Grade 1, 45% (N = 38,370) Grade 2 and 7% (N = 6,279) Grade 3. Patents with Grade 2/3 compared to Grade 1 had significantly increased mortality (7.2% vs. 0.9%, p < 0.001) and serious morbidity (31% vs. 12%, p < 0.001). Colorectal-specific complications including anastomotic leak (3.7% vs. 2.8%, p < 0.001) and prolonged ileus (26% vs. 14%, p < 0.001) were higher in patients with Grade 2/3. Grade 2/3 had increased risk of mortality (odds ratio 3.07, p < 0.001) and serious morbidity (1.78, p < 0.001). Albumin-Bilirubin had excellent accuracy in predicting mortality (area under the curve 0.81, p < 0.001) and serious morbidity (0.70, p < 0.001).
Albumin-Bilirubin is easily calculated using only serum albumin and total bilirubin values. Grade 2/3 is associated with increased rates of mortality and morbidity following colectomy. Albumin-Bilirubin can be applied to risk-stratify patients prior to colectomy.
接受结直肠切除术的肝病患者并发症和死亡率较高。白蛋白-胆红素评分是一种新开发的系统，用于预测肝切除术后的结果，该系统考虑了肝功能障碍。
在美国外科医师学会国家手术质量改进计划 2015-2018 年结直肠切除术靶向数据库中确定所有接受结直肠切除术的患者。比较白蛋白-胆红素分级 1 级与 2/3 级患者的人口统计学和结局。对包括结直肠特异性并发症在内的结局进行多变量回归。计算受试者工作特征曲线下面积以确定白蛋白-胆红素评分的准确性。
在确定的 86273 例患者中，48%（N=41624）为白蛋白-胆红素分级 1 级，45%（N=38370）为分级 2/3 级，7%（N=6279）为分级 3 级。与分级 1 级相比，分级 2/3 级患者的死亡率（7.2% vs. 0.9%，p<0.001）和严重发病率（31% vs. 12%，p<0.001）明显升高。包括吻合口漏（3.7% vs. 2.8%，p<0.001）和肠梗阻延长（26% vs. 14%，p<0.001）在内的结直肠特异性并发症在分级 2/3 级患者中更高。分级 2/3 级患者的死亡率（比值比 3.07，p<0.001）和严重发病率（1.78，p<0.001）风险增加。白蛋白-胆红素在预测死亡率（曲线下面积 0.81，p<0.001）和严重发病率（0.70，p<0.001）方面具有优异的准确性。
仅使用血清白蛋白和总胆红素值即可轻松计算白蛋白-胆红素。分级 2/3 级与结直肠切除术后死亡率和发病率升高有关。白蛋白-胆红素可用于在结直肠切除术前对患者进行风险分层。
