title: Factors affecting serum albumin in the perioperative period of colorectal surgery: a retrospective study.
abstract: BACKGROUND
  Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. Hypoalbuminemia is a risk factor for mortality, postoperative complications, and prolonged hospital stay. The magnitude of the systemic inflammatory response during the perioperative period, as indicated by the acute-phase proteins-C-reactive protein (CRP) in particular-, may help identify the risk of postoperative infectious complication. The correlation between serum albumin and CRP with gastrointestinal cancer has been reported. However, it is unclear whether antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period in colorectal surgery. The primary endpoint of this study was to reveal that antecedent CRP could be utilized to predict future hypoalbuminemia in the perioperative period of colorectal surgery.
  
  
  METHODS
  Thirty-seven patients who underwent elective open colorectal surgery were included in this study. Correlations between preoperative CRP and serum albumin on postoperative day (POD) 3, between preoperative CRP and serum albumin on POD 7 and between CRP on POD 3 and serum albumin on POD 7 were examined. Relationships between preoperative CRP and hypoalbuminemia on POD 3, between preoperative CRP and hypoalbuminemia on POD 7 and between CRP on POD 3 and hypoalbuminemia on POD 7 were examined by receiver operating characteristic analysis.
  
  
  RESULTS
  Three-quarters of patients were older than 65 years of age. Significant correlations were observed between preoperative CRP and serum albumin on POD 3 (p = 0.023), between preoperative CRP and serum albumin on POD 7 (p = 0.023) and between CRP on POD 3 and serum albumin on POD 7 (p < 0.001). The area under the receiver operating characteristic curve of CRP on POD 3 to development of hypoalbuminemia on POD 7 was 0.833 (95 % CI 0.679-0.987) with an optimal threshold of 12.43 mg/dL, sensitivity 75 % and specificity 80 %.
  
  
  CONCLUSIONS
  The present study revealed that antecedent CRP was associated with future serum albumin. Additionally, CRP on POD 3 could be useful in predicting the development of hypoalbuminemia on POD 7. This result suggests that CRP on POD 3 may be a valuable indicator for early nutritional intervention.
authors.affiliation: Department of Pharmacy, Izumi Regional Medical Center, 4513 Akasegawa, Akune, Kagoshima, 899-1611, Japan. akihiro_sonoda@cronos.ocn.ne.jp.|Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan. akihiro_sonoda@cronos.ocn.ne.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sonoda
authors.affiliation: Department of Gastroenterology, Izumi Regional Medical Center, 4513 Akasegawa, Akune, Kagoshima, 899-1611, Japan. shunon@po.synapse.ne.jp.
authors.forename: Shun
authors.initials: S
authors.lastname: Ohnishi
authors.affiliation: Department of Pharmacy, Izumi Regional Medical Center, 4513 Akasegawa, Akune, Kagoshima, 899-1611, Japan. pharmacy@akunehp.com.
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakao
authors.affiliation: Department of Pharmacy, Izumi Regional Medical Center, 4513 Akasegawa, Akune, Kagoshima, 899-1611, Japan. yakuzai@akunehp.com.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Iwashita
authors.affiliation: Department of Pharmacy, Izumi Regional Medical Center, 4513 Akasegawa, Akune, Kagoshima, 899-1611, Japan. color063@yahoo.co.jp.
authors.forename: Naomi
authors.initials: N
authors.lastname: Hashimoto
authors.affiliation: Department of Pharmacy, Izumi Regional Medical Center, 4513 Akasegawa, Akune, Kagoshima, 899-1611, Japan. k_ishida@akunehp.com.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Ishida
authors.affiliation: Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan. ykondo@kumamoto-u.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kondo
authors.affiliation: Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan. y-zuka@gpo.kumamoto-u.ac.jp.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ishitsuka
authors.affiliation: Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan. tirie@gpo.kumamoto-u.ac.jp.|Center for Clinical Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan. tirie@gpo.kumamoto-u.ac.jp.
authors.forename: Tetsumi
authors.initials: T
authors.lastname: Irie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000097:blood / Q000175:diagnosis / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000209:etiology; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D011379:Prognosis; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D013997:Time Factors
chemical_list: D012709:Serum Albumin; D002097:C-Reactive Protein