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The effect of albumın and total proteın values as nutrıtıonal markers after Fontan surgery on prognosıs
Kenan Abdurrahman Kara1, Ergin Arslanoğlu1, Fatih Yigit1
1Department of Pediatric Cardiac Surgery, Kartal Kosuyolu Training And Research Hospital, İstanbul, Türkiye.
Insights
Post-operative albumin and total protein levels in children after the Fontan procedure can predict mortality. Low total protein (<6.65 mg/dl) in the early post-operative period indicates a higher risk of mortality in these pediatric patients.
Area of Science:
- Pediatric Cardiology
- Surgical Outcomes
- Nutritional Biomarkers
Background:
- Children with congenital heart disease (CHD) often experience malnutrition and protein-losing enteropathy post-Fontan procedure.
- Serum albumin and total protein levels are crucial indicators of nutritional status and post-operative care quality in these patients.
- Investigating these markers aids in refining intensive care treatment strategies for Fontan patients.
Purpose of the Study:
- To retrospectively analyze the impact of pre-operative and post-operative albumin and total protein levels on the prognosis of children undergoing the Fontan procedure.
- To identify specific protein level thresholds associated with increased mortality risk in the early post-operative phase.
Main Methods:
- Retrospective analysis of 127 pediatric patients who underwent the Fontan procedure between 2012 and 2021.
- Exclusion of patients who received albumin replacement therapy.
- Statistical analysis of pre-operative and early post-operative (1st, 2nd, 3rd day) albumin and total protein values in relation to mortality.
Main Results:
- No statistically significant correlation was found between pre-operative albumin/total protein and post-operative mortality.
- A significant inverse correlation was observed between early post-operative albumin/total protein levels (days 1-3) and mortality.
- Patients with total protein levels below 6.65 mg/dl in the early post-operative period exhibited significantly higher mortality rates.
Conclusions:
- Early post-operative albumin and total protein levels serve as valuable predictors for Fontan patient prognosis.
- A total protein level below 6.65 mg/dl on post-operative day 1 is a critical indicator of increased mortality risk.
- Pre-operative nutritional optimization, focusing on high protein intake, may be beneficial in reducing early post-operative mortality in Fontan patients.
Introduction:
Children with CHD develop heart failure due to increased pulmonary blood flow, cyanosis, and pulmonary hypertension. The metabolic needs of these children differ from those of healthy children, and malnutrition is common. Protein-losing enteropathy has been reported in 5 to 13% of patients after the Fontan procedure. Serum albumin and total protein levels, which are indicators of the quality of post-operative care, can be useful tools for monitoring and examining the intensive care treatment strategies of these patients. In our retrospective study, the effects of albumin and total protein values, which are two of the markers that give us an idea about diet, nutritional status, and inflammation, on the prognosis of children who underwent the Fontan procedure were investigated.
Method:
In our study, 127 patients who underwent Fontan procedure in our clinic between 2012 and 2021 were analysed retrospectively. Of the patients, 52.7% (n = 67) were male and 47.3% (n = 60) were female. The mean age is 5.83 ± 4.63 years. Patients who underwent albumin replacement were not included in the study.
Results:
Although the relationship between pre-operative albumin and total protein values and post-operative mortality was not statistically significant, the inverse correlation of post-operative albumin 1st, 2nd, and 3rd-day values and post-operative total protein 1st, 2nd, and 3rd-day values with mortality was found to be statistically significant. In addition, we found that mortality was statistically high in patients whose total protein amount was below 6.65 mg/dl in the early post-operative period.
Conclusion:
Albumin and total protein, whose blood levels can vary with diet, can be used as predictors in the early post-operative prognosis of Fontan patients. In addition, when we examined the exitus patients, it was observed that the total protein amount was below 6.65 mg/dl on the post-operative 1st day. Based on this, we think that a diet with high protein content before surgery will help reduce post-operative early mortality.
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