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Variations in plasma thyroxine-binding prealbumin (TBPA) in relation to other circulating proteins in post-operative
Insights
Post-operative stress, not nutrition, impacts thyroxine-binding prealbumin (TBPA) levels. Even with early feeding, TBPA and albumin (ALB) decrease, while inflammatory markers rise, indicating stress response is the primary driver.
Area of Science:
- Biochemistry
- Clinical Nutrition
- Surgical Stress Response
Background:
- Thyroxine-binding prealbumin (TBPA) is a sensitive indicator of nutritional status.
- Post-operative changes in plasma proteins are complex and influenced by multiple factors.
- Understanding TBPA dynamics post-surgery is crucial for assessing patient recovery.
Purpose of the Study:
- To investigate the variations in plasma TBPA levels in post-operative patients.
- To correlate TBPA fluctuations with other nutritional and inflammatory markers.
- To determine the primary influence on TBPA changes: nutritional supply or surgical stress.
Main Methods:
- Plasma TBPA, albumin (ALB), C-reactive protein (CRP), alpha 1-acid-glycoprotein (alpha 1GP), alpha 1-antitrypsin (alpha 1AT), cortisol, and haematocrit were measured in 15 patients.
- Measurements were taken pre-operatively, post-anaesthesia, 2 hours post-consciousness, and daily for 7 days.
- Patients resumed normal oral feeding on the first post-operative day.
Main Results:
- TBPA and ALB levels decreased significantly by day 3 post-surgery.
- Inflammatory markers (CRP, alpha 1GP, alpha 1AT) increased post-operatively.
- Cortisol showed a transient increase, and haematocrit decreased, with most markers not returning to baseline by day 7.
Conclusions:
- Post-operative TBPA variations persist despite early oral feeding.
- Surgical stress response, rather than nutritional intake, appears to be the main determinant of TBPA fluctuations.
- These findings highlight the significant impact of the acute stress response on nutritional markers post-surgery.
Abstract:
Variations in plasma thyroxine-binding prealbumin (TBPA) were investigated in 15 well-nourished patients who underwent minor orthopaedic surgery and resumed normal oral feeding on the first post-operative day. TBPA fluctuations were analysed together with those of other nutritional and inflammatory markers including albumin (ALB), some acute-phase reactant proteins, C-reactive protein (CRP), orosomucoid also named alpha 1-acid-glycoprotein (alpha 1GP), alpha 1-antitrypsin (alpha 1AT) as well as cortisol and haematocrit. Measurements were conducted the day before operation, after the administration of anaesthesia, 2 h after the patient regained consciousness and then daily for a period of one week (days 1 to 7). Assays showed that TBPA and ALB levels began to decline by day 1 reaching minimum values by day 3 (with 35 and 15 per cent total decreases respectively compared to the initial levels). CRP levels began to rise on day 1 reaching maximum levels by day 2, alpha 1 GP and alpha 1 AT started to increase on day 1 and 2 respectively and displayed maximum concentrations by day 3. Cortisol, on the other hand, showed a rapid, yet short-lived increase after the patient regained consciousness on the day of operation. Haematocrit levels decreased from day 1 to day 3 and these low values were maintained until the end of the study. Aside from cortisol and CRP, the initial levels of the other parameters were not yet restored by day 7. These results show that despite an early return to normal oral feeding in post-operative patients, the commonly observed pattern of variation in TBPA levels persisted, indicating that such a pattern seems to be mainly influenced by stress-induced post-operative responses rather than by nutritional supply.