title: Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions.
abstract: BACKGROUND
  Hypoalbuminemia is a well-recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)-induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB-induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes.
  
  
  METHODS
  Prospective observational study conducted in 150 patients, Group 1 ≤18 years (n = 75) and Group 2 >18 years (n = 75) of age. Albumin levels were measured preoperatively (T1), after termination of CPB (T2) and 48 h post-CPB (T3). Primary parameters (mortality, duration of postoperative ventilation, duration of inotropes and duration of Intensive Care Unit [ICU] stay) and secondary parameters (urine output, oliguria, arrhythmias, and hemodynamic parameters) were recorded.
  
  
  RESULTS
  The albumin levels in Group 1 at T1, T2, and T3 were 3.8 ± 0.48, 3.2 ± 0.45 and 2.6 ± 0.71 mg/dL; and in Group 2 were 3.7 ± 0.50, 3.2 ± 0.49 and 2.7 ± 0.62 mg/dL respectively. All patients showed a significant decrease in albumin concentration 48 h after surgery (P < 0.01). Analysis between the groups, however, showed no statistical difference. Eleven patients expired during the study period, and nonsurvivors showed significantly lower serum albumin concentration 48 h after surgery 2.3 ± 0.62 mg/dL versus 3.7 ± 0.56 mg/dL in the survivors (P < 0.05). Receiver operating characteristic curve showed that a baseline albumin cut-off value of 3.3 g/dL predicts mortality with a positive predictive value 47.6% and a negative predictive value of 99.2% (P < 0.05). A strong correlation was seen between albumin levels at 48 h with duration of CPB (r2 = 0.6321), ICU stay (r2 = 0.7447) and incidence of oliguria (r2 = 0.8803).
  
  
  CONCLUSIONS
  The study demonstrated similar fall in albumin concentration in cyanotic patients (both adult and pediatric) in response to CPB. Low preoperative serum albumin concentrations (<3.3 g/dL) can be used to identify and prognosticate subset of cyanotics predisposed to additional surgical risk.
authors.affiliation: Department of Cardiac Anaesthesiology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.forename: Jitin
authors.initials: J
authors.lastname: Narula
authors.forename: Ujjwal Kumar
authors.initials: UK
authors.lastname: Chowdhury
authors.forename: Usha
authors.initials: U
authors.lastname: Kiran
authors.forename: Sameer
authors.initials: S
authors.lastname: Taneja
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D034141:Hypoalbuminemia / Q000209:etiology* / Q000378:metabolism* / Q000401:mortality; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000097:blood; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012121:Respiration, Artificial; D012709:Serum Albumin / Q000032:analysis / Q000378:metabolism*; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery; D055815:Young Adult
chemical_list: D002316:Cardiotonic Agents; D012709:Serum Albumin