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Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions
Poonam Malhotra Kapoor1, Jitin Narula, Ujjwal Kumar Chowdhury
1Department of Cardiac Anaesthesiology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
Insights
Hypoalbuminemia after cardiopulmonary bypass (CPB) surgery in cyanotic congenital heart disease (CCHD) patients significantly impacts outcomes. Low preoperative serum albumin (<3.3 g/dL) predicts increased surgical risk and mortality in these patients.
Area of Science:
- Cardiology
- Biochemistry
- Surgical Risk Assessment
Background:
- Hypoalbuminemia is a known surgical risk factor, common in cyanotic congenital heart disease (CCHD).
- Cardiopulmonary bypass (CPB) and surgical stress can significantly alter serum albumin levels.
- Understanding these changes is crucial for managing CCHD patients undergoing surgery.
Purpose of the Study:
- To track changes in albumin concentration in CCHD patients during and after CPB.
- To determine the impact of hypoalbuminemia on postoperative outcomes in CCHD patients.
- To identify predictive markers for surgical risk in CCHD.
Main Methods:
- Prospective observational study of 150 CCHD patients (75 pediatric, 75 adult).
- Albumin levels measured preoperatively, post-CPB, and 48 hours post-CPB.
- Primary outcomes: mortality, ventilation duration, inotrope use, ICU stay. Secondary outcomes: urine output, oliguria, arrhythmias, hemodynamics.
Main Results:
- All patients showed a significant decrease in albumin 48 hours post-CPB (p < 0.01).
- Nonsurvivors had significantly lower serum albumin 48 hours post-CPB (2.3 vs. 3.7 mg/dL, p < 0.05).
- A baseline albumin cut-off of 3.3 g/dL predicted mortality (PPV 47.6%, NPV 99.2%). Albumin levels correlated with CPB duration, ICU stay, and oliguria.
Conclusions:
- CPB induces a similar drop in albumin in both pediatric and adult CCHD patients.
- Low preoperative serum albumin (<3.3 g/dL) identifies CCHD patients at higher surgical risk.
- Serum albumin levels are valuable for prognostication in CCHD surgical patients.
Introduction:
Hypoalbuminemia is a well-recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)-induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB-induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes.
Materials And Methods:
Prospective observational study conducted in 150 patients, Group 1 ≤18 years (n = 75) and Group 2 >18 years (n = 75) of age. Albumin levels were measured preoperatively (T1), after termination of CPB (T2) and 48 h post-CPB (T3). Primary parameters (mortality, duration of postoperative ventilation, duration of inotropes and duration of Intensive Care Unit [ICU] stay) and secondary parameters (urine output, oliguria, arrhythmias, and hemodynamic parameters) were recorded.
Results:
The albumin levels in Group 1 at T1, T2, and T3 were 3.8 ± 0.48, 3.2 ± 0.45 and 2.6 ± 0.71 mg/dL; and in Group 2 were 3.7 ± 0.50, 3.2 ± 0.49 and 2.7 ± 0.62 mg/dL respectively. All patients showed a significant decrease in albumin concentration 48 h after surgery (P < 0.01). Analysis between the groups, however, showed no statistical difference. Eleven patients expired during the study period, and nonsurvivors showed significantly lower serum albumin concentration 48 h after surgery 2.3 ± 0.62 mg/dL versus 3.7 ± 0.56 mg/dL in the survivors (P < 0.05). Receiver operating characteristic curve showed that a baseline albumin cut-off value of 3.3 g/dL predicts mortality with a positive predictive value 47.6% and a negative predictive value of 99.2% (P < 0.05). A strong correlation was seen between albumin levels at 48 h with duration of CPB (r2 = 0.6321), ICU stay (r2 = 0.7447) and incidence of oliguria (r2 = 0.8803).
Conclusions:
The study demonstrated similar fall in albumin concentration in cyanotic patients (both adult and pediatric) in response to CPB. Low preoperative serum albumin concentrations (<3.3 g/dL) can be used to identify and prognosticate subset of cyanotics predisposed to additional surgical risk.
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