Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre

BMJ Open. 2017 Apr 8;7(4):e013966. doi: 10.1136/bmjopen-2016-013966.


Objective: To test postoperative serum albumin drop (ΔAlb) as a marker of surgical stress response and early predictor of clinical outcomes.

Design: Prospective cohort study (NCT02356484). Albumin was prospectively measured in 138 patients undergoing major abdominal surgery. Blood samples were collected before surgery and on postoperative days 0, 1 2 and 3. ΔAlb was compared to the modified estimation of physiologic ability and surgical stress (mE-PASS) score and correlated to the performances of C reactive protein (CRP), procalcitonin (PCT) and lactate (LCT). Postoperative outcomes were postoperative complications according to Clavien classification and Comprehensive Complication Index (CCI), and length of hospital stay (LoS).

Setting: Department of abdominal surgery in a European tertiary centre.

Participants: Adult patients undergoing elective major abdominal surgery, with anticipated duration ≥2 hours. Patients on immunosuppressive or antibiotic treatments before surgery were excluded.

Results: The level of serum albumin rapidly dropped after surgery. ΔAlb correlated to the mE-PASS score (r=0.275, p=0.01) and to CRP increase (r=0.536, p<0.001). ΔAlb also correlated to overall complications (r=0.485, p<0.001), CCI (r=0.383, p<0.001) and LoS (r=0.468, p<0.001). A ΔAlb ≥10 g/L yielded a sensitivity of 77.1% and a specificity of 67.2% (AUC: 78.3%) to predict complications. Patients with ΔAlb ≥10 g/L on POD 1 showed a threefold increased risk of overall postoperative complications.

Conclusions: Early postoperative decrease of serum albumin correlated with the extent of surgery, its metabolic response and with adverse outcomes such as complications and length of stay. A decreased concentration of serum albumin ≥10 g/L on POD 1 was associated with a threefold increased risk of overall postoperative complications and may thus be used to identify patients at risk.

Keywords: Biomarker; albumin; major surgery; postoperative complications; stress response.

MeSH terms

  • Abdomen / surgery*
  • Adult
  • Aged
  • Biomarkers
  • C-Reactive Protein / metabolism*
  • Calcitonin / metabolism*
  • Elective Surgical Procedures* / adverse effects
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / metabolism*
  • Postoperative Period
  • Predictive Value of Tests
  • Prospective Studies
  • Protein Precursors
  • Serum Albumin / metabolism*
  • Switzerland / epidemiology


  • Biomarkers
  • Protein Precursors
  • Serum Albumin
  • Calcitonin
  • C-Reactive Protein

Associated data