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Postoperative Hypoalbuminemia as a Predictor of Acute Kidney Injury After Open Repair of Ruptured Abdominal Aortic Aneurysm

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Abstract

Background

Perioperative hypoalbuminemia has a prognostic effect on mortality and morbidity in various cohorts. Patients undergoing open repair of ruptured abdominal aortic aneurysms (rAAA) are at a high risk of hypoalbuminemia due to bleeding and underlying diseases. Hence, this study aimed to investigate the predictive value of immediate postoperative hypoalbuminemia for the risk for acute kidney injury (AKI) in patients undergoing open rAAA repair.

Methods

We retrospectively reviewed 143 patients who underwent open rAAA repair between January 2008 and May 2022. The patients were divided into two groups according to the presence of postoperative AKI. The perioperative serum albumin levels of the two groups were compared. The patients were further divided into two groups based on the median immediate postoperative albumin level (2.4 g/dL). The incidence of AKI was compared between the two groups. Multivariate logistic regression analysis was performed to assess the predictors of postoperative AKI. Kaplan-Meier survival curves were used to evaluate potential of AKI and albumin level as prognostic factors for mortality.

Results

Immediate postoperative serum albumin was significantly lower in the AKI group than in the non-AKI group (2.11 ± 0.62 g/dL vs. 2.59 ± 0.62 g/dL, p < 0.001). The incidence of postoperative AKI was significantly higher in patients with albumin ≤ 2.4 g/dL than in patients with albumin > 2.4 g/dL (53.8% vs. 27.7%, p = 0.002). Immediate postoperative albumin level was an independent predictor of AKI (Odds ratio [OR], 0.310; 95% confidence interval [CI] 0.165–0.583, p < 0.001) and 1-year mortality (OR, 0.230; 95% CI 0.098–0.542, p = 0.001).

Conclusions

Immediate postoperative hypoalbuminemia was associated with postoperative AKI and mortality in patients with rAAA.

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Author notes

  1. Hei Jin Yoon and Tae-Hoon Kim are contributed equally to this work.

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea

    Hei Jin Yoon, Da Eun Ko, Jong-Wook Song, Narhyun Min & Sung Yeon Ham

  2. Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea

    Tae-Hoon Kim

  3. Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea

    Jong-Wook Song & Sung Yeon Ham

  4. Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul, 06273, South Korea

    Sung Yeon Ham

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  1. Hei Jin Yoon
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Correspondence to Sung Yeon Ham.

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Ethical approval

This study was approved by institutional review board of Yonsei University Health System (Protocol No.3-2022-0428). The need for informed consent was waived because of the retrospective nature.

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Yoon, H.J., Kim, TH., Ko, D.E. et al. Postoperative Hypoalbuminemia as a Predictor of Acute Kidney Injury After Open Repair of Ruptured Abdominal Aortic Aneurysm. World J Surg 47, 3382–3393 (2023). https://doi.org/10.1007/s00268-023-07178-z

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  • DOI: https://doi.org/10.1007/s00268-023-07178-z

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