Preoperative hypoalbuminemia is associated with an increased risk for intra-abdominal septic complications after primary anastomosis for Crohn’s disease

术前低蛋白血症会增加克罗恩病一期肠吻合术后腹腔内感染性并发症的发生风险

Objective:The aim of this study was to evaluate the impact of preoperative hypoalbuminemia on the development of intraabdominal septic complications(IASCs)after primary anastomosis for patients with Crohn’s disease(CD).Methods:All CD patients undergoing bowel resection with a primary anastomosis during the study period from 2007 to 2015 were enrolled.The association of preoperative hypoalbuminemia(<30 g/L)with the risk for IASCs were assessed using both univariate and multivariate analyses.Results:A total of 124 eligible patients were included,117(94.4%)of whom had available preoperative albumin level.Preoperative hypoalbuminemia occurred in 13(11.7%)patients.The duration fromdiagnosis to surgery was longer for patients with preoperative hypoalbuminemia than those without(p=0.012).Patients with preoperative hypoalbuminemia weremore likely to have a history of preoperative use of 5-aminosalicylic acid(p=0.013)and have an intraoperative finding of small bowel obstruction(p=0.015).Of all patients,24(19.4%)developed postoperative IASCs.Univariate analysis showed that patients with preoperative hypoalbuminemia had an increased risk for IASCs(p=0.012).Multivariate analysis confirmed the association between preoperative hypoalbuminemia and IASCs(odds ratio 4.67,95%confidence interval:1.28–17.04,p=0.02).Similar findings were also obtained when preoperative albumin level was analysed as a continuous variable(p=0.019).Conclusions:Preoperative hypoalbuminemia is a significant predictor for the development of postoperative IASCs in CD patients after bowel resection with a primary anastomosis.Favorable preoperative nutrition status might lessen the risk for IASCs.

目的:本研究旨在探讨术前低蛋白血症对克罗恩病(CD)患者一期肠吻合术后发生腹腔内感染性并发症(IASCs)的影响。方法:2007-2015年期间所有行肠切除一期肠吻合手术的CD患者纳入研究。采用单因素和多因素分析评估术前低蛋白血症(白蛋白<30 g/L)与术后IASCs发生风险的关系。结果:共计124例患者纳入研究,其中117例(94.4%)可以获得术前白蛋白水平的数据。13例(11.7%)患者术前合并低蛋白血症。相较之下,术前低蛋白血症患者CD诊断至手术的间期更长(P=0.012),术前服用5氨基水杨酸的比例更高(P=0.013),术中发现小肠梗阻的比例更高(P=0.015)。共有24例(19.4%)患者术后出现IASCs。单因素分析显示,术前低蛋白血症患者术后IASCs风险更高(P=0.012)。多因素分析证实,术前低蛋白血症是术后IASCs的独立危险因素(OR=4.67,95%CI:1.28–17.04,P=0.02)。将术前白蛋白水平作为一个连续型变量进行多因素分析,亦可得到相同的结果(P=0.019)。结论:对于行肠切除一期肠吻合的CD患者,术前低蛋白血症提示术后IASCs发生风险增高。改善术前营养状态或可降低术后IASCs的发生风险。