Prognostic Value of Serum Albumin in Aortic Aneurysm Patients Undergoing Graft Replacement of Ascending Aorta and Aortic Arch

Abstract

Background: Hypoalbuminemia is a marker of poor overall health with influences from protein energy

malnutrition, systemic inflammation and hepatic and renal disease. Albumin has been reported to have a

prognostic impact in various cohorts. This study investigated whether preoperative serum albumin levels

could be used to predict mortality in patients with aortic aneurysms undergoing graft replacement of

ascending aorta and aortic arch.

Methods: We retrospectively reviewed 183 patients who underwent graft replacement of ascending

aorta and aortic arch between January 2010 and December 2020. The exclusion criteria included patients

with traumatic aortic injuries (n=2), previous aortic repair within 6 months (n=2), ruptured aortic

aneurysms (n=14), or a lack of preoperative laboratory data or medical records (n=10). The remaining

87% eligible patients were divided into two groups based on their preoperative serum albumin levels. The

lower albumin group was defined as having serum albumin levels ≤3.5 g/dL, while the higher albumin

group was defined as having albumin levels >3.5 g/dL. The incidence of mortality was compared between

the two groups, and a logistic regression analysis was performed to evaluate the predictors of mortality.

Results: The incidence of 1-year mortality was higher in the lower albumin group than in the higher

albumin group (3.4% vs. 23.5%, p=0.006). The optimal cut-off value of albumin to predict 1-year mortality

was 4.0 g/dL (area under the curve 0.885, 95% CI 0.821–0.949, p<0.001), with a sensitivity and specificity

of 90.0% and 80.3%, respectively. Preoperative serum albumin levels (OR = 0.116, 95% CI 0.021-0.641,

p=0.014) and diabetes mellitus (OR = 5.757, 95% CI 1.018-32.565, p=0.048) remained independent

predictors of mortality.

Conclusion: Preoperative serum albumin levels were an independent predictor of 1-year mortality after

the graft replacement of ascending aorta and aortic arch. These findings underscore that the optimization

of patients' nutritional status before surgery may be warranted and should be further explored in this

high-risk population.