title: Can Serum Albumin Level and Total Lymphocyte Count be Surrogates for Malnutrition to Predict Wound Complications After Total Knee Arthroplasty?
abstract: Although the serum albumin level and total lymphocyte count (TLC) have been reported as valid and reliable markers for defining malnutrition, their cutoff levels and predictive values for wound complications in patients undergoing total knee arthroplasty (TKA) remain questionable.
  
  
  
  A total of 3169 TKAs performed between April 2003 and December 2013 were retrospectively reviewed. We determined the prevalence of malnutrition on applying different definitions, with various cutoff values of serum albumin and TLC and analyzed the variations in outcome. The differences between groups with and without malnutrition in terms of functional outcome and complications were determined using Student's t test and analysis of variance. Multivariate logistic regression analysis was conducted to identify the independent risk factors.
  
  
  
  Among all the patients (N = 3169), the serum albumin level and TLC varied widely, with means of 4.1 g/dL and 2189 cells/mm(3), respectively. The prevalence of malnutrition (21%) as per the conventional definition (serum albumin level <3.5 g/dL or a serum TLC <1500 cells/mm(3)) dropped to only 1.6% when malnutrition was defined as serum albumin <3.5 g/dL "and" TLC <1500/mm(3), indicating a very small overlap between the 2 markers. No differences were observed between 2 groups in functional outcomes and incidence of wound complications.
  
  
  
  Our findings call into question the values of serum albumin level and TLC as a surrogate of malnutrition for predicting wound complications after TKA.
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Vivek M
authors.initials: VM
authors.lastname: Morey
authors.affiliation: Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.
authors.forename: Young Dong
authors.initials: YD
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Ji Sup
authors.initials: JS
authors.lastname: Whang
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Yeon Gwi
authors.initials: YG
authors.lastname: Kang
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Tae Kyun
authors.initials: TK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D018655:Lymphocyte Count; D008297:Male; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D015995:Prevalence; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014945:Wound Healing
chemical_list: D015415:Biomarkers; D012709:Serum Albumin
keywords: malnutrition; periprosthetic joint infection; serologic markers; total knee arthroplasty; wound complications