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 level could be used for predicting mortality in aortic aneurysm patients 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. Patients were divided into two groups based on cut-off value obtained from combined receiver-operating characteristic curve analysis. Lower albumin group was defined as serum albumin <4.0 g/dL. The incidence of mortality was compared between the two groups, and logistic regression analysis was performed to evaluate the predictors for mortality. Results: The optimal cut-off value of albumin to predict 1-year mortality was 4 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. The incidence of 1-year mortality was higher in the lower albumin group than the normal albumin group (0.7% vs. 20.9%, p<0.001). 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 as independent predictors of 1-year mortality. Conclusion: Preoperative serum albumin level was an independent predictor of 1-year mortality after surgical repair of aortic aneurysm. Optimization of patients' nutritional status before surgery may be warranted and should be further explored in this high risk population.