Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection

Table 1 Patient characteristics

Characteristic	n = 223
Age in yr	62.3 ± 9.9
Sex, n
Male	159
Female	64
BMI in kg/m2	23.0 ± 3.4
Comorbidities, n
Diabetes mellitus	15
Hypertension	72
Preoperative serum albumin in g/L	38.3 ± 3.2
Preoperative hemoglobin in g/L	123.4 ± 24.9
Preoperative CRP in g/L	6.6 ± 10.3
CA 19-9 in ng/mL
≥ 37	43
< 37	180
CEA in ng/mL
≥ 5	26
< 5	197
Lymphocyte count as × 109/L
≥ 3	9
< 3	214
CRP on POD 3 in mg/L	99.7 ± 60.9
ALB on POD 1 in g/L	32.7 ± 3.6
ASA ≥ 3, n	122
Clinical stage I/II/III/IV, n	67/44/103/9
Mode of surgical approach, n
Laparoscopic	18
Open	205
Type of resection, n
Distal gastrectomy	82
Proximal gastrectomy	24
Total gastrectomy	117
Degree of lymph node dissection ≥ 2, n	180
Operation time in min	239.1 ± 66.9
Blood loss in mL	228.6 ± 146.2
Postoperative complications as Clavien-Dindo grade, n
I and II	40
≥ III	22
Postoperative stay in d	15.8 ± 8.6

ALB: Albumin; ASA: American Society of Anesthesiologists; BMI: Body mass index; CA 19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; CRP: C-reactive protein; POD: Postoperative day.

Table 2 Univariate analysis of risk factors associated with postoperative complications

Characteristic	OR	95%CI	P value
Age ≥ 75 yr	1.330	0.476-3.715	0.586
Sex	0.642	0.342-1.202	0.166
BMI of < 18.5 kg/m2	0.277	0.034-2.232	0.228
Comorbidities
Diabetes mellitus	3.259	1.128-9.414	0.029
Hypertension	0.728	0.382-1.389	0.336
Preoperative serum albumin of < 35 g/L	1.048	1.018-1.109	0.015
Preoperative hemoglobin of < 120 g/L	1.487	0.817-2.705	0.194
Preoperative CRP of ≥ 10 g/L	1.336	0.512-3.486	0.553
CA 19-9 of ≥ 37 ng/mL	1.328	0.647-2.723	0.439
CEA of ≥ 5 ng/mL	1.177	0.483-2.865	0.720
Lymphocyte count of ≥ 3 × 109/L	0.314	0.038-2.560	0.279
CRP on POD 3 in mg/L	4.653	2.435-8.889	< 0.001
△ALB of ≥ 14.0%	16.837	6.403-44.275	< 0.001
ASA of ≥ 3	1.007	0.559-1.815	0.981
Clinical stage of ≥ II	1.798	1.255-2.686	0.009
Mode of surgical approach	1.206	0.588-2.475	0.610
Type of resection	1.291	1.006-1.896	0.013
Degree of lymph node dissection ≥ 2	2.263	0.948-5.399	0.066
Operation time of ≥ 250 min	1.621	0.896-2.931	0.110
Blood loss of ≥ 200 mL	1.417	0.758-2.651	0.275

∆ALB: (Albumin level before surgery-albumin on POD 1)/albumin level before surgery × 100%; ASA: American Society of Anesthesiologists; BMI: Body mass index; CA 19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; CRP: C-reactive protein; POD: Postoperative day.

Table 3 Multivariate analysis of risk factors associated with postoperative complications

Characteristic	OR	95%CI	P value
Age ≥ 75 yr	1.053	0.248-4.470	0.945
Sex	0.572	0.237-1.380	0.214
BMI of < 18.5 kg/m2	0.147	0.013-1.666	0.122
Comorbidities
Diabetes mellitus	1.234	0.322-4.726	0.759
Hypertension	0.989	0.397-2.463	0.981
Preoperative serum albumin of < 35 g/L	0.914	0.897-1.067	0.093
Preoperative hemoglobin of < 120 g/L	1.804	0.748-4.353	0.189
Preoperative CRP of ≥ 10 g/L	1.008	0.210-4.840	0.993
CA 19-9 of ≥ 37 ng/mL	1.197	0.431-3.327	0.730
CEA of ≥ 5 ng/mL	0.794	0.233-2.706	0.713
Lymphocyte count of ≥ 3 × 109/L	0.192	0.018-2.048	0.172
CRP on POD 3 in mg/L	4.296	1.887-9.780	0.001
△ALB of ≥ 14.0%	17.957	6.073-53.095	< 0.001
ASA of ≥ 3	0.929	0.406-2.127	0.861
Clinical stage of ≥ II	1.198	0.355-2.286	0.109
Mode of surgical approach	1.737	0.576-5.235	0.327
Type of resection	0.791	0.506-1.896	0.063
Degree of lymph node dissection ≥ 2	3.485	1.163-10.446	0.026
Operation time of ≥ 250 min	1.448	0.624-3.355	0.389
Blood loss of ≥ 200 mL	1.418	0.636-3.160	0.393

∆ALB: (Albumin level before surgery-albumin on POD 1)/albumin level before surgery × 100%; ASA: American Society of Anesthesiologists; BMI: Body mass index; CA 19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; CRP: C-reactive protein; POD: Postoperative day.

Table 4 Univariate analysis of postoperative complications associated with median value of ∆ALB

Characteristic	All, n = 223	∆ALB < 14.0%, n = 101	∆ALB ≥ 14.0%, n = 122	P value
Overall13	62 (27.8)	5 (5.0)	57 (46.7)	< 0.001
Mild complications13	40 (17.9)	3 (3.0)	37 (30.3)	< 0.001
Major complications13	22 (9.9)	2 (2.0)	20 (16.4)	< 0.001
Postoperative stay in d2	15.8 ± 8.6	14.1 ± 4.2	17.2 ± 10.8	0.007
CCI all patients4	0 (0-20.9)	0 (0-0)	8.7 (0-26.2)	< 0.001

¹Clavien-Dindo’s classification of surgical complications;

²Values are expressed as the median ± SD;

³Values are expressed as n (%);

⁴Values are expressed as median (interquartile range); ∆ALB: (Albumin level before surgery-albumin on POD 1)/albumin level before surgery × 100%; CCI: Comprehensive complication index.