Prevention And Treatment Of Hypoalbuminemia After Hepatectomy

Objective:To investigate the risk and protective factors of hypoalbuminemia after hepatectomy and to provide prevention and treatment strategies for hypoalbuminemia after hepatectomy.Methods:Clinical data of 1178 patients undergoing hepatectomy were collected from March 2012 to August 2017 in our hospital including 980 patients undergoing open hepatectomy and 198 patients undergoing laparoscopic hepatectomy.The incidence of postoperative hypoalbuminemia was compared between the laparoscopic and open groups after the confounding factors were balanced by propensity score matching.Univariate and multivariate logistic regression analysis were used to confirm the protective factors and risk factors after hepatectomy.At the same time,receiver operating curve(ROC curve)was used to determine the optimal cut-off value of protective factors and risk factors.Finally,ROC curve was used to analyze the dose of human serum albumin in patients with different levels of albuminemia to determine the appropriate value of human serum albumin dose.Results:According to inclusion and exclusion criteria,a total of 1178 patients were enrolled,including 980 patients who received open hepatectomy and 198 patients who received laparoscopic hepatectomy.A total of 471 cases were successfully matched according to the propensity score matching ratio of laparoscopic hepatectomy group to open hepatectomy group=2:1,including 296 cases in the open hepatectomy group and 175 cases in the laparoscopic hepatectomy group.After matching,there was no significant difference in preoperative general data between the two groups.The serum albumin concentration of laparoscopic hepatectomy group were significantly higher than those of open hepatectomy group on POD 1,3,5 and 7(33.61±3.62 vs 31.88±4.18g/L,P<0.001).34.74±3.55 vs 32.84±3.86g/L,P<0.001;36.62±4.10 vs 34.77±4.62g/L,P<0.001;37.95±4.33 vs 36.60±4.95g/L,P=0.003),the incidences of hypoalbuminemia were significantly lower than those of open hepatectomy group(62.3%vs 78.4%,P<0.001;51.4%vs 71.6%,P<0.001;37.1%vs 51.4%P=0.003;27.4%vs 39.9%,P=0.006).Multivariate logistic regression analysis showed that preoperative serum albumin concentration(OR:821,95%CI:0.733-0.920,P=0.001)was a protective factor for hypoalbuminemia after laparoscopic hepatectomy,and preoperative alanine aminotransferase levels(OR:1.025,95%CI:1.025,P=0.001)was a risk factor for hypoalbuminemia after laparoscopic hepatectomy.Preoperative serum albumin concentration(OR:0.825,95%CI:0.743-0.916,P<0.001)was a risk factor for hypoalbuminemia after open hepatectomy.ROC curve analysis showed that serum albumin was higher than 42.95 g/L before laparoscopic hepatectomy(sensitivity=47.7%;Specificity=85.5%)and serum albumin concentration before open hepatectomy was higher than 40.85 g/L(sensitivity=69.4%;Specificity=60.0%)may prevent the occurrence of postoperative hypoalbuminemia.ROC curve analysis was performed on serum albumin concentration and dose of human serum albumin in patients.For patients with mild hypoalbuminemia after laparoscopic hepatectomy,human serum albumin supplementation was not required,while 0-10 g/d human serum albumin supplementation was required for patients with moderate hypoalbuminemia.For patients with mild and moderate hypoalbuminemia after open hepatectomy,human serum albumin should be supplemented with 0-10 g/d and 10-20 g/d for patients with severe hypoalbuminemia.