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Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study
Open accessAbstract
Background. Surgical stress during major surgery may be related to adverse clinical outcomes and early quantification of stress response would be useful to allow prompt interventions. The aim of this study was to evaluate the acute phase protein albumin in the context of the postoperative stress response.Methods. This prospective pilot study included 70 patients undergoing frequent abdominal procedures of different magnitude. Albumin (Alb) and C-reactive protein (CRP) levels were measured once daily starting the day before surgery until postoperative day (POD) 5. Maximal Alb decrease (Alb Δ min) was correlated with clinical parameters of surgical stress, postoperative complications, and length of stay.Results. Albumin values dropped immediately after surgery by about 10 g/L (42.2±4.5 g/L preoperatively versus 33.8±5.3 g/L at day 1,P<0.001). Alb Δ min was correlated with operation length (Pearsonρ=0.470,P<0.001), estimated blood loss (ρ=0.605,P<0.001), and maximal CRP values (ρ=0.391,P=0.002). Alb Δ min levels were significantly higher in patients having complications (10.0±5.4 versus 6.1±5.2,P=0.005) and a longer hospital stay (ρ=0.285,P<0.020).Conclusion. Early postoperative albumin drop appeared to reflect the magnitude of surgical trauma and was correlated with adverse clinical outcomes. Its promising role as early marker for stress response deserves further prospective evaluation.
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“Thereafter, CRP drops quickly after 3–4 days to low, but still modestly increased, levels if the proinflammatory phase is successful.147”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [147]
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“Thereafter, in the anti‐inflammatory phase, CRP is neither a precise indicator of the severity of the metabolic response, nor a very precise indicator of whether there is improvement or deterioration of the clinical state.147”
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BackgroundResultSignificance of admission hypoalbuminemia in acute intracerebral hemorrhage
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“Alb, a sensitive indicator in response to surgical stress, has also been suggested as a useful predictor of postoperative complications [12].”
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“In contrast to fibrinogen, hypoalbuminemia could be a result of an acute metabolic stress response after ICH [39,40].”
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“Low albumin levels reduce colloid osmotic pressure, increase capillary permeability, and diminish antioxidant effects, thereby impairing postoperative recovery [28, 29].”
BackgroundCompromised Activation of Vitamin D After Elective Surgery: A Prospective Pilot Study
Jensen, M. B., Husted, H., Bjerrum, P. J., Juul, A., & Kehlet, H. (2018) · JBMR Plus · doi:10.1002/jbm4.10053 · Cited by 14
“Total 25-OH (nmol/L) 57 (30) 60 (31) Free 25-OH (pmol/L) 14 (15) 13 (7) Total 1,25(OH)2D3 (pmol/L) 70 (30) 82 (34) Free 1,25(OH)2D3 (pmol/L) 0.”
Shao, C., Liu, K., Li, C., Cong, Z., Hu, L., Luo, J., Diao, Y., Xu, Y., Ji, S., Qiang, Y., et al. (2019) · Thoracic Cancer · doi:10.1111/1759-7714.12990 · Cited by 14
Jiang, G., Du, X., Zhu, Y., Zhang, M., Qin, W., Xiong, T., & Ou, Y. (2022) · BioMed Research International · doi:10.1155/2022/4946848 · Cited by 13
“(a) First, bleeding following surgery removes some of the albumin from the blood and dilutes the remaining serum albumin concentration [24].”
Personalized diagnostic approach and indirect quantification of extravasation in human anaphylaxis
Nuñez‐Borque, E., Betancor, D., Pastor‐Vargas, C., Fernández‐Bravo, S., Martín-Blázquez, A., Casado‐Navarro, N., López‐Domínguez, D., Gómez‐López, A., del Río, P. R., Tramón, P., et al. (2022) · Allergy · doi:10.1111/all.15443 · Cited by 13
Albumin and fibrinogen synthesis rates in advanced chronic liver disease
Amouzandeh, M., Sundström, A., Wahlin, S., Wernerman, J., Rooyackers, O., & Norberg, Å. (2023) · American Journal of Physiology-Gastrointestinal and Liver Physiology · doi:10.1152/ajpgi.00072.2023 · Cited by 12
Nutritional intervention in cognitively impaired geriatric trauma patients: a feasibility study
Eschbach, D. A., Kirchbichler, T., Wiesmann, T., Oberkircher, L., Bliemel, C., Ruchholtz, S., & Bücking, B. (2016) · Clinical Interventions in Aging · doi:10.2147/cia.s109281 · Cited by 12
Biochemical implications of robotic surgery: a new frontier in the operating room
Mokhtari, L., Hosseinzadeh, F., & Nourazarian, A. (2024) · Journal of Robotic Surgery · doi:10.1007/s11701-024-01861-6 · Cited by 11
“In addition, these robotic techniques also help maintain antioxidant levels by reducing surgical stress and preserving liver and kidney function [78, 79].”
Sharath Kumar, V., Prakash, D., & Pottendla, V. K. (2019) · International Surgery Journal · doi:10.18203/2349-2902.isj20190383 · Cited by 11
“The correct assessment of the nutritional status of such patients is crucial since malnutrition is a risk factor for morbidity and mortality.(3) Decrease in the serum albumin level preoperatively which is a risk factor for surgical complications is associated with increased hospital cost, increased length of hospital…”
BackgroundLennon, S., Hughes, C. J., Muazzam, A., Townsend, P. A., Gethings, L. A., Wilson, I. D., & Plumb, R. S. (2021) · Journal of Proteome Research · doi:10.1021/acs.jproteome.0c00821 · Cited by 11
Nakano, Y., Kitago, M., Shinoda, M., Yagi, H., Abe, Y., Takano, K., Oshima, G., Takeuch, A., Endo, Y., & Kitagawa, Y. (2019) · Molecular and Clinical Oncology · doi:10.3892/mco.2019.1883 · Cited by 11
Qu, G., Wang, D., Xu, W., Wu, K., & Guo, W. (2021) · International Journal of General Medicine · doi:10.2147/ijgm.s299167 · Cited by 11
Okui, J., Ueno, R., Matsui, H., Uegami, W., Hayashi, H., Miyajima, T., & Kusanagi, H. (2020) · Journal of Infection and Chemotherapy · doi:10.1016/j.jiac.2020.04.009 · Cited by 10
Kordzadeh, A., Tokidis, E., Askari, A., Hoff, M., & Panayiotopoulos, Y. P. (2017) · The Journal of Vascular Access · doi:10.5301/jva.5000646 · Cited by 10
“ISSN 1129-7298 J Vasc Access 2017; 18 (2): 148-152”
BackgroundPostoperative CD4 counts predict anastomotic leaks in patients with penetrating abdominal trauma
Mauser, M., Bartsokas, C., Brand, M., & Plani, F. (2018) · Injury · doi:10.1016/j.injury.2018.11.028 · Cited by 10
Park, S., Shin, Y.-R., Hur, H., Lee, C. M., Min, J.-S., Ryu, S. W., Chae, H., Jeong, O., Choi, C. I., Song, K. Y., et al. (2023) · Chinese Journal of Cancer Research · doi:10.21147/j.issn.1000-9604.2023.06.10 · Cited by 9
How could we identify the ‘old’ patient in gastric cancer surgery? A single centre cohort study
Solaini, L., Ministrini, S., Coniglio, A., Cavallari, S., Molteni, B., Baiocchi, G. L., Portolani, N., & Tiberio, G. A. M. (2016) · International Journal of Surgery · doi:10.1016/j.ijsu.2016.09.004 · Cited by 9
Serum albumin level difference in burn injury after tangential excision: A prospective cohort study
Soedjana, H., Bowo, S. A., Putri, N. M., & Davita, T. R. (2020) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2020.02.007 · Cited by 9
“Albumin is produced exclusively in the liver, representing 50% of its protein synthesis, and can be upregulated to threefold if the oncotic pressure decreases [2,3].”
BackgroundTóthová, C., Mihajlovičová, X., Novotny, J. F., Nagy, O., Giretová, M., Krešáková, L., Tomco, M., Žert, Z., Vilhanová, Z., Varga, M., et al. (2019) · Materials · doi:10.3390/ma12010142 · Cited by 9
“[26], the decrease in the concentrations of albumin in early post operation may reflect the magnitude of surgical trauma and predict adverse clinical outcomes.”
BackgroundSeretis, C., Gill, J., Malik, A. A., Elhassan, A. M., Shariff, U. S., & Youssef, H. (2020) · Journal of Clinical Medicine Research · doi:10.14740/jocmr4362 · Cited by 8
“The latter is of great importance in surgical oncology, as apart from the surgical stress and the subsequent catabolic cascade, the operable patients can frequently be in preclinical stages of cancer-related cachexia with evolving skeletal muscle depletion [31, 32].”
BackgroundIdentifying the best candidates for reduced port gastrectomy
Chung, J. H., Hwang, J., Park, S. H., Kim, K.-Y., Cho, G. S., Kim, Y. M., Shin, H. J., Lee, S.-H., Hwang, S.-H., Hyung, W. J., et al. (2023) · Gastric Cancer · doi:10.1007/s10120-023-01438-6 · Cited by 8
Jeong, H.-W., Kim, J.-W., Shin, W., Kim, S., Moon, Y., Kwon, H., Jung, K., Jun, I., Song, J., & Hwang, G. (2019) · Scientific Reports · doi:10.1038/s41598-019-39126-0 · Cited by 8
Lee, W., Tang, J., Li, A., Zhu, Y., Ling, X., Cang, J., Jang, S., & Fang, F. (2020) · Gland Surgery · doi:10.21037/gs-20-533 · Cited by 8
“Considering the same perioperative treatment in both groups, the difference may due to a longer operation in the TP-RALP group which was associated with operative trauma and increased catabolism (19-21).”
BackgroundSerum Albumin Kinetics in Major Ovarian, Gastrointestinal, and Cervico Facial Cancer Surgery
Motamed, C., Mariani, L., Suria, S., & Weil, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063394 · Cited by 8
“The decrease in plasma albumin concentration following surgery is well known and documented [13], with these authors finding it to be a significant predictor for clinical outcomes”
BackgroundInfluentialMiyamoto, M., Kobayashi, Y., Miyata, E., Sakagami, T., Yagi, M., Kanda, A., Michiura, T., & Tomoda, K. (2017) · Dysphagia · doi:10.1007/s00455-017-9793-3 · Cited by 8
Man, W.-H., Lin, H., Liu, Z., Jin, L., Wang, J., Zhang, J., Bai, Z., Yao, H., Zhang, Z., & Deng, W. (2020) · Cancer Management and Research · doi:10.2147/cmar.s234448 · Cited by 8
“main disadvantages are low predictive accuracy and high time lag.(18,19) CRP and white blood cell levels increase nonspecifically in response to surgical stress.”
BackgroundLiu, Z., Chen, L., Sun, F., Lv, B., Ge, X., Shao, L., & Liu, S. (2022) · Nutrition and Cancer · doi:10.1080/01635581.2022.2083190 · Cited by 8
“At the same time, due to surgical trauma and inflammatory reaction, and other reasons, ALB will decrease significantly 4 to 6 h, after operation (26).”
BackgroundGau, R.-Y., Tsai, H., Yu, M., Chan, K., Lee, W., Wang, H.-E., Wang, S.-F., Cheng, M., Chiu, C.-C., Chen, H., et al. (2022) · World Journal of Surgical Oncology · doi:10.1186/s12957-022-02854-1 · Cited by 7
“Since albumin is known to indicate the global nutritional status, and hypoalbuminemia, similar to sarcopenia, has been found to be predictive of early postoperative outcome after liver resection and its drop is also a marker of stress response, laparoscopic liver resection thus can maintain a better nutritional profil…”
BackgroundBhattacharyya, A., Ramamoorthy, L., & Pottakkat, B. (2021) · Journal of Caring Sciences · doi:10.34172/jcs.2021.030 · Cited by 7
Serum Albumin: A Promising Biomarker to Anticipate Postoperative Complications
Labgaa, I., Demartines, N., & Hübner, M. (2017) · Diseases of the Colon & Rectum · doi:10.1097/dcr.0000000000000848 · Cited by 7
“In our article, we pointed out the study’s limitation as a retrospective observational study(1) and also cited the article by Hübner et al.(6) Labgaa et al(2) did perform a good prospective cohort study and extrapolated the role of Δalbumin in other types of abdominal surgery besides colorectal resection.”
MethodResultSelf-citationWang, J., Yu, H., Xu, X. J., & Guo, J. (2025) · Clinical Interventions in Aging · doi:10.2147/cia.s523802 · Cited by 6
Hu, K., Tan, K., Shang, Q., Li, C., Zhang, Z., Huang, B., Zhao, S., Li, F., Zhang, A., Li, C., et al. (2023) · BMC Surgery · doi:10.1186/s12893-023-01923-w · Cited by 6
“And due to a variety of advantages of ∆ALB including reflection of the inflammatory response, quicker kinetics, and easy availability [14], ∆ALB has been suggested to serve as a potential biomarker to predict postoperative complications, which may exhibit an earlier predictive ability than CRP [10].”
BackgroundLabgaa, I., Cano, L., Mangana, O., Joliat, G., Melloul, E., Halkic, N., Schäfer, M., Vibert, É., Demartines, N., Golse, N., et al. (2022) · Perioperative Medicine · doi:10.1186/s13741-022-00285-w · Cited by 6
“This drop was followed by a plateau and recovery phases, which was consistent with a pilot study in liver surgery, as well as in other types of surgery (Labgaa et al. 2016a, 2017c; Ryan et al. 2007; Hubner et al. 2016).”
ResultSelf-citationFigueiredo, S. G., Labgaa, I., Demartines, N., Schäfer, M., & Joliat, G. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12030972 · Cited by 6
Self-citationKisani, A. I., Tughgba, T., & Elsa, A. T. (2018) · Veterinary World · doi:10.14202/vetworld.2018.909-914 · Cited by 6
“Assessment of ALB in 2 h disagrees with the findings that ALB can only be assessed in 4-6 h [43].”
MethodMendoza, A. M., Llanos, J. P. S., Morales, A. S., González, C. L., Huerta, Y. Z., & de Segura, I. L. G. (2020) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2019.07.008 · Cited by 6
Kumar, D. M., & Sivakumar, S. (2020) · International Surgery Journal · doi:10.18203/2349-2902.isj20201390 · Cited by 6
“The albumin response was also related to clinical outcomes.(4)”
Background
Metadata
- Authors
- Hübner, M., Mantziari, S., Demartines, N., Pralong, F., Coti-Bertrand, P., & Schäfer, M.
- Affiliations
- Centre Hospitalier Universitaire Vaudois (CH)
- Department of Visceral Surgery and Transplantation and Department of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland
- Corresponding author
- Demartines, Nicolas
- Venue
- Gastroenterology Research and Practice
- Publisher
- Hindawi Limited
- Published
- 2016
- Volume
- 2016
- Pages
- 1-8
- ISSN
- 1687-6121 (ISSN-L)
- 1687-630X
- PMC
- PMC4736779
- OpenAlex
- W2223161052
- Cited by
- 191
- References
- 45
- Citations by year
- 2026: 19 · 2025: 15 · 2024: 9 · 2023: 15 · 2022: 28 · 2021: 22 · 2020: 24 · 2019: 21 · 2018: 17 · 2017: 18 · 2016: 3
- FWCI
- 21.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Gastroenterology Research and Practice (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- SERVAL (Université de Lausanne) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Keywords
- surgical stress response, acute phase proteins, C-reactive protein, postoperative complications, length of hospital stay, abdominal surgery, surgical trauma, blood loss, early biomarkers
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