CLINICAL CHARACTERISTICS OF PREOPERATIVE HYPOALBUMINEMIA PREDICT OUTCOME OF CARDIOVASCULAR-SURGERY

Objective: To define the clinical characteristics and outcome of preop erative hypoalbuminemia in adult cardiovascular surgery. Study: Incept ion cohort. Setting: Adult cardiovascular intensive care unit (CVICU). Patients: Admissions to CVICU between January 1 and December 31, 1993 . Intervention: Preoperative hypoalbuminemia (serum albumin less than or equal to 3.5 g/dL) was classified by the presence of malnutrition c achexia (body mass index of less than or equal to 20 kg/m(2)), liver i nsufficiency (serum bilirubin greater than or equal to 2.0 mg/dL), his tory of congestive heart failure, or hypoalbuminemia alone. Demographi cs, chronic diseases, systemic hemodynamics, and laboratory data were obtained at preoperative and later on admission and during the stay in the CVICU. Outcome measures: Postoperative organ dysfunction, nosocom ial infections, length of mechanical ventilation, hospitalization and death. Results: A total of 2,743 patients (91%) of 3,025 patients who were admitted to the CVICU were enrolled in the study. Preoperative hy poalbuminemia was found in 325 patients (12%): hypoalbuminemia and cac hexia in 21 patients (6%), hypoalbuminemia and liver insufficiency in 26 patients (8%), hypoalbuminemia and history of congestive heart fail ure in 102 patients (31%), and hypoalbuminemia alone in 176 patients ( 54%). Clinical features of preoperative hypoalbuminemia were age great er than or equal to 75 years, female gender, left, ventricular ejectio n fraction less than or equal to 35%, hematocrit less than or equal to 34%, serum creatinine greater than or equal to 1.9 mg/dL, systemic ox ygen delivery less than or equal to 350 mL/min . m(2), acute stressful conditions leg, infective endocarditis, acute myocardial infarction, or emergency surgery) and chronic obstructive pulmonary airway disease . Redo operations, combined valve and coronary artery bypass graft, mi tral valve replacement, and thoracic aortic surgery were the commonest types of surgery performed in these patients. All types of hypoalbumi nemia except for malnutrition cachexia increased the likelihood of pos toperative organ dysfunction (cardiac, pulmonary, renal, hepatic, and neurologic), gastrointestinal bleeding, nosocomial infections, length of mechanical ventilation, stay in the CVICU, and hospital death. Cach ectic hypoalbuminemia increased the requirement for postoperative pare nteral nutrition and prolonged the length of stay in hospital. Conclus ion: Preoperative hypoalbuminemia was attributed to malnutrition cache xia, liver insufficiency or congestive heart failure in <50% of cardia c patients undergoing cardiovascular surgery AU types of hypoalbuminem ia except for malnutrition cachexia increased the Likelihood of postop erative organ dysfunction, nosocomial infections, prolonged mechanical ventilation, and death. The morbidity and mortality attributed to hyp oalbuminemia could be explained by the underlying clinical characteris tics rather than malnutrition cachexia in cardiac patients.