Impact of Serum Albumin on Functional Status and Hospital Outcome in Oldest-Old Inpatients

Association of Preoperative Functional Status With Short-Term Major Adverse Outcomes After Cardiac Surgery

Introduction Cardiac surgery plays a crucial role in treating a wide range of cardiovascular conditions, offering life-saving interventions for patients with diseases such as coronary artery disease, heart valve disorders, and heart failure. However, these procedures are not without significant risks, including complications such as stroke, acute kidney injury, respiratory failure, and infections. It is important to not only recognize the potential complications associated with these procedures but also identify high-risk patients early in the treatment process. With the aging population and the increasing burden of comorbidities, a growing number of patients are likely to present with suboptimal functional status prior to cardiac surgery. By incorporating functional status into preoperative evaluations, healthcare providers can improve patient selection, enhance perioperative care, and improve outcomes in this high-risk patient population. Therefore, this study aims to investigate whether preoperative dependent functional status is associated with an increased risk of postoperative major adverse outcomes in patients undergoing cardiac surgery. Methods We performed a retrospective cohort analysis on adult cardiac surgery patients based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2011-2021 database. We compared a primary composite outcome consisting of post-surgery outcomes between independent and partially/totally dependent patients. The primary outcome was defined as experiencing any of the following adverse events: superficial incisional/deep incisional/organ space surgical site infection, death within 30 days post-operation, stroke/cerebral vascular accident (CVA), cardiac arrest requiring cardiopulmonary resuscitation (CPR), myocardial infarction, pulmonary embolism (PE), deep vein thrombosis (DVT)/thrombophlebitis, progressive renal insufficiency, ventilator use for more than 48 hours post-operation, unplanned intubation or reoperation, sepsis, septic shock, and pneumonia. Confounding variables were age, gender, race, emergency case, comorbidities, and baseline laboratory markers. We used multivariable logistic regression analysis to obtain adjusted odds ratio (OR) and 95% confidence intervals (CIs). Results Of the 42,917 patients included in the study, 30.6% were female and 69.4% were male, with 46.5% of the group being 65-79 years old. The prevalence of dependent status was 2.6%. Compared to independent patients, those who were dependent had a higher incidence of the primary outcome (35.68% vs. 20.93%), yielding a crude OR of 2.09 (95% CI 1.85-2.37). The association remained significant: OR of 1.21 (95% CI 1.04-1.41) after adjustment for age, gender, race, body mass index (BMI), emergency case, and other comorbidities such as diabetes, hypertension, heart failure, preoperative blood transfusion or sepsis, and laboratory markers. Conclusion Patients with preoperative dependent functional status were found to have a significantly greater risk of complications after cardiac surgery, even after adjusting for demographics, comorbidities, laboratory markers, and perioperative characteristics. Further investigation is needed to explore the development and clinical application of a predictive tool that includes functional status, which could help identify high-risk patients and facilitate timely interventions such as prehabilitation programs to enhance functional capacity.

Low blood pressure is associated with acute kidney injury development and mortality in octogenarians admitted to the emergency room

AIM

The aim of the present study was to evaluate the incidence, risk factors, clinical characteristics and outcomes of acute kidney injury (AKI) in octogenarians admitted to the emergency room, and to compare these parameters with those in a younger group of patients admitted in the same period.

METHODS

This is a prospective, observational, single-center study that enrolled adult patients admitted to the emergency room of Shaare Zedek Medical Center, Jerusalem, Israel. Patients were stratified by age (≥80 years or <80 years) and followed up prospectively until discharge. The incidence of AKI, in-hospital mortality and duration of hospital stay were recorded.

RESULTS

Of 319 patients, 128 were octogenarians (mean age 86.7 years, range 80-105 years) and 191 were younger (mean age 60.6 years, range 18-79 years). The incidence of AKI and in-hospital mortality was significantly higher in octogenarians (16.4% vs 12.6%, P = 0.039 and 15.6% vs 3.1%, P = 0.001, respectively). In multivariate analysis, only low systolic blood pressure at admission in octogenarians (P = 0.002), and a history of chronic kidney disease (P < 0.001) and hypoalbuminemia (P = 0.001) in the younger patients were independent risk factors for AKI.

CONCLUSION

The present results confirm the observation that AKI is common in octogenarians. We identified systolic blood pressure as the only independent variable associated with AKI in octogenarians. However, the role of therapeutic strategies aimed to increase systolic blood pressure and diminish complications in octogenarians remains to be elucidated. Geriatr Gerontol Int 2019; 19: 874-878.

Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease

OBJECTIVE

Coronary heart disease (CHD) is a leading cause of death in developed countries. Exploration of indicators to identify high risk individuals who develop adverse outcomes despite stable baseline condition is important. This study is to evaluate the association between serum albumin concentration and cardiovascular (CV) outcomes in individuals of stable CHD.

METHODS

Seven-hundred-thirty-four participants from Biosignature study, a nationwide prospective cohort study aimed to identity risk factors among patients with stable CHD, were enrolled for analysis. They were divided into low serum albumin group (baseline albumin concentration <3.5g/dL, n=98) and normal albumin group (baseline albumin concentration ≥3.5g/dL, n=636). The relations between baseline albumin and adverse CV outcomes within 18months of follow-up were analyzed.

RESULTS

Compared baseline characteristics with normal albumin group, subjects in low albumin group are older, having more diabetic patients, lower hemoglobin level, lower estimated glomerular filtration rate, lower total cholesterol level, lower left ventricular ejection fraction, and higher blood glucose. While there is no significant difference of total CV events between two groups, low serum albumin concentration is associated with an increased risk of all-cause mortality (10.2% vs. 0.5%, p<0.001) and hard CV events (7.1% vs. 1.4%, p<0.001). The association remains significant after adjustments for confounders (all-cause mortality, HR: 6.81, 95% CI: 1.01-45.62; hard CV events, HR: 3.68, 95% CI: 1.03-13.19).

CONCLUSIONS

Low serum albumin concentration (<3.5g/dL) worsens prognosis of patients with stable CHD.