Influence of preoperative albumin on mortality following surgery for infective endocarditis: A systematic review &...

BackgroundInfective endocarditis is a life-threatening condition requiring surgical intervention in certain cases. Despite advances in surgical techniques and medical management, postoperative mortality remains high. Preoperative optimisation, including the assessment of preoperative albumin levels, may play a crucial role in improving surgical outcomes. This systematic review and meta-analysis examine the relationship between preoperative albumin levels and in hospital mortality of patients undergoing cardiac surgery for IE.Materials & MethodsFollowing the PRISMA guidelines, a comprehensive search of PubMed, MEDLINE via Ovid, Embase, Scopus, ClinicalGov, and Cochrane CENTRAL was performed. Studies including patients with IE who underwent cardiac surgery with documented preoperative albumin levels were selected. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale (NOS). Statistical analyses were conducted to evaluate the impact of albumin levels on postoperative mortality.ResultA total of nine studies involving 1863 patients met the inclusion criteria. Meta-analysis demonstrated significantly lower preoperative albumin levels in patients who did not survive following surgery. A random-effects meta-analysis showed a significant large effect (SMD = 1.14, 95% CI: 0.63 to 1.64). However, heterogeneity was substantial (I² = 91%), indicating considerable variability in effect sizes across studies. There was no publication bias with visual inspection of funnel plots and Egger's test (p = 0.388).ConclusionPreoperative hypoalbuminemia is strongly associated with increased mortality in patients undergoing surgery for IE. Given that most IE surgeries are non-emergent, addressing low albumin levels preoperatively may offer a significant therapeutic opportunity to improve surgical outcomes.