Hypoalbuminemia Linked to Worse Outcomes After IBD Surgery

By Reuters Staff

May 16, 2019

NEW YORK (Reuters Health) - Hypoalbuminemia is associated with worse mortality and complication rates after major abdominal surgery related to inflammatory bowel disease (IBD), according to a database study.

Serum albumin has been shown to be a predictor of postoperative outcomes in non-cardiac surgeries, and hypoalbuminemia is present in about one in five patients with IBD, even early in the course of disease. As many as 80% of hospitalized patients with ulcerative colitis and 50% of those with Crohn's disease are found to have hypoalbuminemia.

Dr. Geoffrey C. Nguyen from Mount Sinai Hospital Center for Inflammatory Bowel Disease and University of Toronto, Canada, and colleagues used data from the American College of Surgeons' National Surgical Quality Improvement Program to assess the impact of hypoalbuminemia in more than 10,900 IBD patients who underwent IBD-related bowel surgery between 2005 and 2012.

Among these patients, the prevalence of modest hypoalbuminemia (3.0-3.4 g/dL) was 17% and that of severe hypoalbuminemia (<3.0 g/dL) 24%, the team reports in the Journal of Crohn's and Colitis, online April 23.

Modest and severe hypoalbuminemia were associated with significantly higher 30-day mortality in patients with Crohn's disease (0.7% and 2.4%, respectively) and in patients with ulcerative colitis (0.9% and 5.6%), compared with patients with normal albumin levels (0.2% with Crohn's disease and 0.1% with ulcerative colitis).

Severe hypoalbuminemia was also linked with significantly higher rates of infectious complications and higher incidences of wound dehiscence.

Different degrees of hypoalbuminemia were also associated with higher rates of postoperative bleeding requiring transfusion, cardiac complications and neurologic complications and, in patients with ulcerative colitis, with higher rates of renal complications.

On multivariable analysis, severe hypoalbuminemia was independently associated with 93% greater odds of postoperative complications in Crohn's disease and with 2.08-fold greater odds of postoperative complications in ulcerative colitis.

"This study has definitively established the association between preoperative hypoalbuminemia and short-term postoperative outcomes in the largest IBD surgical cohort to date," the researchers conclude.

"In patients with hypoalbuminemia, increased vigilance should be exercised to detect early and mitigate life-threatening complications such as sepsis and VTE," they add. "Optimizing process measures for managing of indwelling catheters and implementation of infection control procedures and VTE prophylaxis may reduce some of the impact of preoperative hypoalbuminemia on postoperative complications. Importantly, as a prognostic indicator, preoperative albumin levels may enable surgeons to stratify risk of postoperative complications and inform their patients accordingly."

Dr. Nguyen did not respond to a request for comments.

SOURCE: https://bit.ly/2Q3EPgh

J Crohns Colitis 2019.