Association of low preoperative serum albumin concentrations and the acutephase response

Objective: To investigate the incidence of a preoperative acute phase respo nse and its association with low albumin concentrations. Design: Prospective open study. Setting: Teaching hospital, Germany. Subjects: 225 patients who were to undergo major abdominal operations, and who had no acute infections. Interventions: Measurements of serum concentrations of albumin, C-reactive protein (CRP), alpha-1 antitrypsin, and interleukin-6 (IL-6). Results: Abnormal concentrations of acute phase proteins (indicating an acu te phase response) were detected in 43 of 225 patients (19%). The mean (SD) albumin concentration in these patients (35[5]g/L) was lower than that of patients who did not mount an acute phase response preoperatively (40[5]g/L ). High concentrations of CRP (greater than or equal to 60mg/L) were associ ated with low albumin concentrations (33[5]g/L); high alpha-1 antitrypsin c oncentrations (greater than or equal to 4.0g/L) were associated with low al bumin concentrations (34[6]g/L); and high IL-6 concentrations (greater than or equal to 4pg/ml) were associated with low albumin concentrations (37[6] g/L) compared with a mean(SD) albumin concentration of 40(5)g/L in patients who had no evidence of an acute phase response. Conclusion: A metabolic response to disease referred to as an acute phase r esponse may explain low preoperative albumin concentrations. This associati on interferes with the association of low preoperative albumin concentratio ns and malnutrition. It is a new aspect of preoperative risk evaluation and may indicate a potential for prevention.