Body mass index and albumin in the preoperative evaluation of cardiac surgery patients.
OBJECTIVE
An increasing proportion of cardiac surgery is performed in the elderly where nutritional status is an important predictor of outcome. Our aim was to evaluate serum albumin concentration (S-albumin) and body mass index (BMI) as markers of malnutrition in relation to outcome measured as mortality and frequency of infections.


METHODS
We studied 886 consecutive patients who underwent cardiac surgery with extra-corporeal circulation for valve procedures, coronary artery bypass grafting or a combination of those. Preoperative assessment included age, gender, BMI, smoking habits, diabetes, left-ventricular function, S-albumin and C-reactive protein. Postoperative data was type of surgery, in-hospital stay, signs of infections and mortality. Risk factors for mortality were identified using the Cox proportional hazard model and risk factors for infections by using the logistic-regression model.


RESULTS
The patients (age 67+/-9.5 years) were followed for 22+/-6 months. In an univariate analysis low BMI and low S-albumin increased relative hazard for death and risk for infection. In a multivariate analysis low BMI, but not S-albumin, increased relative hazard for death and low S-albumin, but not BMI, increased risk for infection. Age, diabetes and longer bypass time increased the risk for infection.


CONCLUSIONS
In cardiac surgery patients a low BMI increased the relative hazard for death and low S-albumin increased the risk for infection. We suggest that these parameters provide useful information in the preoperative evaluation.
Rapp-Kesek
Doris
D
Department of Surgical Sciences, Anaesthesiology and Intensive Care, University Hospital, Uppsala, Sweden. doris.kesek@kirvet.uu.se
Ståhle
Elisabeth
E
Karlsson
T Torbjörn
TT
D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D016896:Treatment Outcome
D012709:Serum Albumin