title: Preoperative Hypoalbuminemia is a Risk Factor for Early and Late Mortality in Patients Undergoing Endovascular Juxtarenal and Thoracoabdominal Aortic Aneurysm Repair.
abstract: BACKGROUND
  Advances in endovascular aneurysm repair now allow surgeons to treat high-risk patients with complex aortic aneurysms. Stringent selection criteria for repair exist from an anatomic and technical perspective; however, there is a paucity of literature examining frailty in patients being evaluated for fenestrated and branched endovascular aortic repair (FEVAR). As a marker of frailty well supported in the literature, we hypothesized that preoperative hypoalbuminemia would increase risk for short-term mortality after endovascular juxtarenal and thoracoabdominal aortic aneurysm repair.
  
  
  METHODS
  One thousand eighty nine consecutive patients with juxtarenal and thoracoabdominal aortic aneurysms considered high risk for open surgery from a single institution who underwent FEVAR from 2001 to 2014 were included in the study. Risk factors for all-cause mortality were identified via a Cox regression model on time to death.
  
  
  RESULTS
  The patients with severe hypoalbuminemia (albumin <2.4 g/dL) had significantly increased 30-day mortality (P = 0.025, odds ratio [OR]: 4.967 (95% CI: 1.385-17.814, normal versus severe) and 2-year mortality P = 0.006, OR: 2.4, 95% CI: 1.05-5.73, normal versus severe), as well as increased 30-day complication rates P = 0.026, OR: 1.91, 95% CI: 0.9-4.17, normal versus severe). A univariate analysis for 30-day mortality revealed no significant difference in median age: 75.1 vs. 72.5 years (alive at 30 days (Q1, Q3: 69.8, 80.1) versus expired (Q1, Q3: 69.3, 77.8), P = 0.24.
  
  
  CONCLUSIONS
  Patients with hypoalbuminemia have significantly increased mortality risk. Albumin level is regulated by nutritional intake and inflammation due to chronic disease, which make it a useful part of a preoperative frailty assessment. Further studies are needed to identify whether optimizing nutrition status will affect albumin levels or decrease mortality.
authors.affiliation: Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH; Division of Vascular Surgery, Department of Surgery, Froedtert Hospital and the Medical College of Wisconsin, Milwaukee, WI. Electronic address: max.wohlauer@gmail.com.
authors.forename: Max
authors.initials: M
authors.lastname: Wohlauer
authors.affiliation: Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
authors.forename: Corey
authors.initials: C
authors.lastname: Brier
authors.affiliation: Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kuramochi
authors.affiliation: Department of Vascular Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH.
authors.forename: Matthew
authors.initials: M
authors.lastname: Eagleton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D015536:Down-Regulation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D000073496:Frailty / Q000175:diagnosis / Q000401:mortality; D015577:Geriatric Assessment; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000175:diagnosis / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D015596:Nutrition Assessment; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000075462:Serum Albumin, Human / Q000378:metabolism*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D000075462:Serum Albumin, Human