Fibrinogen and albumin synthesis rates in major upper abdominal surgery

PLoS One. 2022 Oct 27;17(10):e0276775. doi: 10.1371/journal.pone.0276775. eCollection 2022.

Abstract

Plasma fibrinogen and albumin concentrations initially decrease after abdominal surgery. On postoperative days 3-5 fibrinogen concentration returns to the preoperative level or even higher, while albumin stays low. It is not known if these altered plasma concentrations reflect changes in synthesis rate, utilization, or both. In particular a low albumin plasma concentration has often been attributed to a low synthesis rate, which is not always the case. The objective of this study was to determine fibrinogen and albumin quantitative synthesis rates in patients undergoing major upper abdominal surgery with and without intact liver size. Patients undergoing liver or pancreatic resection (n = 9+6) were studied preoperatively, on postoperative days 1 and 3-5. De novo synthesis of fibrinogen and albumin was determined; in addition, several biomarkers indicative of fibrinogen utilization were monitored. After hemihepatectomy, fibrinogen synthesis was 2-3-fold higher on postoperative day 1 than preoperatively. On postoperative days 3-5 the synthesis level was still higher than preoperatively. Following major liver resections albumin synthesis was not altered postoperatively compared to preoperative values. After pancreatic resection, on postoperative day 1 fibrinogen synthesis was 5-6-fold higher than preoperatively and albumin synthesis 1.5-fold higher. On postoperative days 3-5, synthesis levels returned to preoperative levels. Despite decreases in plasma concentrations, de novo synthesis of fibrinogen was markedly stimulated on postoperative day 1 after both hemihepatectomies and pancreatectomies, while de novo albumin synthesis remained grossly unchanged. The less pronounced changes seen following hepatectomies were possibly related to the loss of liver tissue.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen / surgery
  • Digestive System Surgical Procedures*
  • Fibrinogen* / biosynthesis
  • Hemostatics*
  • Hepatectomy
  • Humans
  • Liver / surgery
  • Serum Albumin* / biosynthesis

Substances

  • Fibrinogen
  • Hemostatics
  • Serum Albumin

Grants and funding

OR received grands from the Stockholm County Council(https://www.regionstockholm.se) for this study(Grandnr:ALF20190403). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.