背景:血清白蛋白反映营养状况,并与术后并发症和死亡率相关。δ白蛋白(ΔAlb),定义为术前和术后最低水平之间的差异,可以预测并发症和死亡率,即使术后水平高于30g/L提示白蛋白输注。本研究旨在评估ΔAlb与开颅手术患者脑肿瘤预后的关系。
方法:这项回顾性研究筛选了2010年12月至2021年4月在中国一家医院接受脑外科手术的脑肿瘤患者。患者根据其ΔAlb水平分为四组:<5g/L(正常),5-9.9g/L(轻度ΔAlb),10-14.9g/L(中等ΔAlb),≥15g/L(重度ΔAlb)。主要结果是术后30天死亡率。
结果:在9660例脑肿瘤开颅手术患者中,开颅手术后ΔAlb水平中位数为7.3g/L。ΔAlb与术后30天死亡率增加相关;轻度的赔率(OR),中度,重度ΔAlb为1.93(95%CI,1.17-3.18,P=0.01),2.21(95%CI,1.28-3.79,P=0.004),和7.26(95%CI,4.19-12.58,P<0.01),分别。重要的是,发现ΔAlb>5g/L与较高的死亡风险有很强的关联。即使当最低点Alb保持大于30g/L(OR,1.84;95%CI,1.13-3.00,P=0.014)。
结论:在接受开颅手术切除脑肿瘤的患者中,轻度的ΔAlb与30天死亡率增加有关,即使最低点Alb保持大于30g/L。此外,ΔAlb与术后并发症和住院时间有关。
BACKGROUND: Serum albumin reflects nutritional status and is associated with postoperative complications and mortality. Delta albumin (ΔAlb), defined as the difference between preoperative and lowest postoperative levels, could predict complications and mortality, even with post-op levels above 30 g/L prompting albumin infusions. This study aimed to assess how ΔAlb relates to outcomes in craniotomy patients with brain tumors.
METHODS: This retrospective study screened patients diagnosed with a brain tumor who underwent cerebral surgery from a single Chinese hospital between December 2010 and April 2021. Patients were divided into four groups based on their ΔAlb levels: <5 g/L (normal), 5-9.9 g/L (mild ΔAlb), 10-14.9 g/L (moderate ΔAlb), and ≥15 g/L (severe ΔAlb). The primary outcome was postoperative 30-day mortality.
RESULTS: Among the 9660 patients undergoing craniotomy for brain tumors, the median ΔAlb level after craniotomy was 7.3 g/L. ΔAlb was associated with increased postoperative 30-day mortality; Odds ratios (OR) for mild, moderate, and severe ΔAlb were 1.93(95% CI, 1.17-3.18,P=0.01), 2.21(95% CI, 1.28-3.79,P=0.004), and 7.26(95% CI, 4.19-12.58,P<0.01), respectively. Significantly, ΔAlb >5g/L was found to have a strong association with a higher risk of mortality, even when the nadir Alb remained greater than 30 g/L (OR, 1.84; 95% CI, 1.13- 3.00, P=0.014).
CONCLUSIONS: Among patients undergoing craniotomy for brain tumor resection, a mild degree of ΔAlb was associated with increased 30-day mortality, even if the nadir Alb remained greater than 30 g/L. Moreover, ΔAlb was associated with postoperative complications and longer lengths of stay.