Assessment of preoperative and postoperative prealbumin in thoracic surgery – a two months experience in a Romanian university hospital / Evaluarea preoperatorie şi postoperatorie a prealbuminei în chirurgia toracică - experiența de 2 luni a unui spital universitar din România

Open access


Malnutrition is a frequent and serious finding in surgical departments. Although its consequences include postoperative complications and higher costs, nutritional assessment is not part of the routine preoperative protocols. Nutritional assessment involves clinical and biological parameters and is vital in order to start treatment and improve outcome. Prealbumin is currently recognized as a faithful marker of malnutrition being introduced in practice guidelines. One of the most important aspects about prealbumin is the fact that its variations in time are more valuable than the absolute values. The aim of this study was to assess and compare the perioperative nutritional evolution of patients requiring thoracic surgery, with and without cancer, using prealbumin - preoperative and postoperative - as main marker. Thirty six patients from the Thoracic Surgery Department were assessed prior to surgery by body mass index, Subjective Global Assessment nutrition risk score and routine biochemical parameters. Prealbumin was assessed prior to surgery and 3 days after surgery. The age, length of postoperative stay and the presence was complications was noted. Patients with cancer (n=19) were significantly older than patients without cancer (p=0.007) and were more frequently, but not significantly, evaluated as malnourished through SGA (42.1% compared to 11.6%). Preoperative prealbumin and other parameters did not differ significantly between groups. However, there was a significant postoperative decrease in prealbumin only in patients with cancer. Therefore, prealbumin has been found to be valuable in assessing acute malnutrition in cancer patients, especially if variations are monitored in time, which could be useful in planning nutritional treatment

1. Corkins MR, Guenter P, Di-Maria-Ghalili RA, Jensen GL, Malone A, Miller S, et al; American Society for Parenteral and Enteral Nutrition. Malnutrition Diagnoses in Hospitalized Patients: United States, 2010. JPEN J Parenter Enteral Nutr. 2014 Feb;38(2):186-95. DOI: 10.1177/0148607113512154

2. Nechifor VA, Trufă DI, Ciută CM, Graur LI, Potorac I, Graur M. Perioperative nutritional status. RJDNMD 2011;18(4):391-397.

3. Cross MB, Yi PH, Thomas CF, Garcia J, Della Valle CJ. Evaluation of Malnutrition in Orthopaedic Surgery. J Am Acad Orthop Surg. 2014 Mar;22(3):193-9. DOI: 10.5435/JAAOS-22-03-193

4. Shum J, Markiewicz MR, Park E, Bui T, Lubek J, Bell RB, et al. Low Prealbumin Level Is a Risk Factor for Microvascular Free Flap Failure. J Oral Maxillofac Surg. 2014 Jan;72:169-77. DOI: 10.1016/j.joms.2013.05.022

5. Thieme RD, Cutchma G, Chieferdecker MEM, Campos ACL. Nutritional risk index is predictor of postoperative complications in operations of digestive system or abdominal wall? Arq Bras Cir Dig. 2013 Nov-Dec;26(4):286-92. DOI: 10.1590/S0102-67202013000400007

6. Klidjian AM, Archer TJ, Foster KJ, Karran SJ. Detection of Dangerous malnutrition. JPEN J Parenter Enteral Nutr. 1982 Mar-Apr;6:119-21. DOI: 10.1177/0148607182006002119

7. Chen D, Bao L, Lu S-Q, Xu F. Serum Albumin and Prealbumin Predict the Poor Outcome of Traumatic Brain Injury. PLoS One. 2014 Mar 26;9(3):e93167. DOI: 10.1371/journal.pone.0093167

8. Wie G-A, Cho Y-A, Kim S-Y, Kim SM, Bae JM, Joung H. Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea. Nutrition. 2010 Mar;26:263-8. DOI: 10.1016/j.nut.2009.04.013

9. Bozzetti F, Migliavacca S, Gallus G, Radaelli G, Scotti A, Bonalumi MG, et al. “Nutritional” Markers as Prognostic Indicators of Postoperative Sepsis in Cancer Patients. JPEN J Parenter Enteral Nutr. 1985 Jul- Aug;9:464-70. DOI: 10.1177/0148607185009004464

10. Burden ST, Hill J, Shaffer JL, Todd C. Nutritional status of preoperative colorectal cancer patients. J Hum Nutr Diet. 2010 Aug;23:402-7. DOI: 10.1111/j.1365-277X.2010.01070.x

11. Kubrak C, Jensen L. Malnutrition in acute care patients: A narrative review. Int J Nurs Stud. 2007 Aug;44:1036-54. DOI: 10.1016/j.ijnurstu.2006.07.015

12. Buxbaum JN, Reixach N. Transthyretin: the servant of many masters. Cell Mol Life Sci. 2009 Oct;66:3095-101. DOI: 10.1007/s00018-009-0109-0

13. Devakonda A, George L, Raoof S, Esan A, Saleh A, Bernstein LH. Transthyretin as a marker to predict outcome in critically ill patients. Clin Biochem. 2008 Oct;41(14-15):1126-30. DOI: 10.1016/j.clinbiochem.2008.06.016

14. Moghazy AM, Adly OA, Abbas AH, Moati TA, Ali OS, Mohamed BA. Assessment of the relation between prealbumin serum level and healing of skin grafted burn wounds. Burns. 2010 Jun;36:495-500. DOI: 10.1016/j. burns.2009.05.014

15. Yang HT, Yim H, Cho YS, Kim D, Hur J, Kim JH, et al. Prediction of clinical outcomes for massively- burned patients via serum transthyretin levels in the early postburn period. J Trauma Acute Care Surg. 2012 Apr;72(4):999-1005. DOI: 10.1097/ TA.0b013e3182413bd8

16. Donini LM, Savina C, Ricciardi LM, Coletti C, Paolini M, Scavone L, et al. Predicting the outcome of artificial nutrition by clinical and functional indices. Nutrition. 2009 Jan;25:11-9. DOI: 10.1016/j.nut.2008.07.001

17. White JV, Guenter P, Jensen G, Malone A, Schofield M; Academy Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Board of Directors. Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). JPEN J Parenter Enteral Nutr. 2012 May;36(3):275-83. DOI: 10.1177/0148607112440285

18. Delikaris P, Conlan AA, Silvis N, Studii R, Curcio CA. Nutritional status of thoracic surgical patients. S Afr Med J. 1983 Nov;64:818-20.

19. Bagan P, Berna P, De Dominicis F, Das Neves Pereira JC, Mordant P, De La Tour B, et al. Nutritional Status and Postoperative Outcome After Pneumonectomy for Lung Cancer. Ann Thorac Surg. 2013 Feb;95(2):392-6. DOI: 10.1016/j.athoracsur.2012.06.023

20. Jagoe RT, Goodship HJ, Gibson J. Nutritional Status of Patients Undergoing Lung Cancer Operations. Ann Thorac Surg. 2001 Mar;71:929-35. DOI: 10.1016/ S0003-4975(00)02005-1 DOI: 10.1016/S0003-4975(00)02006-3

21. Luo H, Zhu B, Gong L, Yang J, Jiang Y, Zhou X. The Value of Serum Prealbumin in the Diagnosis and Therapeutic Response of Tuberculosis: A Retrospective Study. PLoS One. 2013 Nov 19;8(11):e79940. DOI: 10.1371/journal.pone.0079940

22. Detsky AS, Mclaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987 Jan-Feb;11(1):8-13. DOI: 10.1177/014860718701100108

23. Kawai H, Ota H. Low Perioperative Serum Prealbumin Predicts Early Recurrence after Curative Pulmonary Resection for Non-Small-Cell Lung Cancer. World J Surg. 2012 Dec;36(12):2853-7. DOI: 10.1007/s00268-012-1766-y

24. Prealbumin in Nutritional Care Consensus Group. Measurement of visceral protein status in assessing protein and energy malnutrition: standard of care. Nutrition. 1995 Mar-Apr;11(2):169-71.

25. Fouque D, Pelletier S, Mafra D, Chauveau P. Nutrition and chronic kidney disease. Kidney Int. 2011 Aug;80(4):348-57. DOI: 10.1038/ki.2011.118

26. Rambod M, Kovesdy CP, Bross R, Kopple JD, Kalantar- Zadeh K. Association of serum prealbumin and its changes over time with clinical outcomes and survival in patients receiving hemodialysis. Am J Clin Nutr. 2008 Dec;88:1485-94. DOI: 10.3945/ajcn.2008.25906

27. Yu P-J, Cassiere HA, Dellis SL, Manetta F, Kohn N, Hartman AR. Impact of Preoperative Prealbumin on Outcomes After Cardiac Surgery. JPEN J Parenter Enteral Nutr. 2014 Jun 4. pii: 0148607114536735. [Epub ahead of print]. DOI: 10.1177/0148607114536735

28. Cavallin F, Scarpa M, Cagol M, Alfieri R, Castoro C. Low Perioperative Serum Prealbumin Predicts Early Recurrence After Curative Pulmonary Resection for Non-Small-Cell Lung Cancer (Letter to the editor). World J Surg. 2013 Aug;37:2005. DOI: 10.1007/ s00268-013-1937-5

29. Kawai H. Low Perioperative Prealbumin Level Predicts Early Recurrence After Curative Pulmonary Resection for Non-small Cell Lung Cancer (comment on). World J Surg. 2013 Aug;37:2006. DOI: 10.1007/s00268-013-1985-x

30. Baicus C, Hristea A, Baicus A. Evaluation of Diagnostic Tests: Receiver Operating Characteristic Curves. Rev Romana Med Lab. 2011;19(3):303-6.

31. Caccialanza R, Palladini G, Klersy C, Cereda E, Bonardi C, Quarleri L, et al. Serum prealbumin: An independent marker of short-term energy intake in the presence of multiple-organ disease involvement. Nutrition. 2013 Mar;29:580-2. DOI: 10.1016/j.nut.2012.08.007

32. Myron Johnson A, Merlini G, Sheldon J, Ichihara K; Scientific Division Committee on Plasma Proteins (CPP), International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clin Chem Lab Med. 2007;45(3):419-26. DOI: 10.1515/CCLM.2007.051

33. Beck FK, Rosenthal TC. Prealbumin: A Marker for Nutritional Evaluation. Am Fam Physician. 2002 Apr;65:1575-8.

34. Davis CJ, Sowa D, Keim KS, Kinnare K, Peterson S. The use of prealbumin and C-reactive protein for monitoring nutrition support in adult patients receiving enteral nutrition in an urban medical center. JPEN J Parenter Enteral Nutr. 2012 Mar;36(2):197-204. DOI: 10.1177/0148607111413896

35. Sharma A, Giraddi G, Krishnan G, Shahi AK. Efficacy of Serum Prealbumin and CRP Levels as Monitoring Tools for Patients with Fascial Space Infections of Odontogenic Origin: A Clinicobiochemical Study. J Maxillofac Oral Surg. 2014 Mar;13(1):1-9. DOI: 10.1007/s12663-012-0376-4

36. Bernstein LH. The systemic inflammatory response syndrome C-reactive protein and transthyretin conundrum. Clin Chem Lab Med. 2007;45(11):1566-7; author reply 1568-9. DOI: 10.1515/CCLM.2007.334

37. Chertow GM, Goldstein-Fuchs DJ, Lazarus JM, Kaysen GA. Prealbumin, mortality, and cause-specific hospitalization in hemodialysis patients. Kidney Int. 2005 Dec;68(6):2794-800. DOI: 10.1111/j.1523-1755.2005.00751.x

38. Dalrymple LS, Johansen KL, Chertow GM, Grimes B, Anand S, McCulloch CE, et al. Longitudinal measures of serum albumin and prealbumin concentrations in incident dialysis patients: the comprehensive dialysis study. J Ren Nutr. 2013 Mar;23(2):91-7. DOI: 10.1053/j.jrn.2012.03.001

39. Herselman M, Esau N, Kruger JM, Labadarios D, Moosa MR. Relationship between serum protein and mortality in adults on long-term hemodialysis: Exhaustive review and meta-analysis. Nutrition. 2010 Jan;26:10-32. DOI: 10.1016/j.nut.2009.07.009

40. Lin MY, Liu WY, Tolan AM, Aboulian A, Petrie BA, Stabile BE. Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer. Am Surg. 2011 Oct;77(10):1286-9.

41. Fujii T, Sutoh T, Morita H, Katoh T, Yajima R, Tsutsumi S, et al. Serum albumin is superior to prealbumin for predicting short-term recurrence in patients with operable colorectal cancer. Nutr Cancer. 2012;64(8):1169-73. DOI: 10.1080/01635581.2012.718034

42. Badia-Tahull MB, Cobo-Sacristán S, Leiva-Badosa E, Miquel-Zurita ME, Méndez-Cabalerio N, Jódar-Masanés R, et al. Use of Subjective Global Assessment, Patient-Generated Subjective Global Assessment and Nutritional Risk Screening 2002 to evaluate the nutritional status of non-critically ill patients on parenteral nutrition. Nutr Hosp. 2014 Feb;29(2):411-9. DOI: 10.3305/nh.2014.29.2.7045

43. Coltman A, Peterson S, Roehl K, Roosevelt H, Sowa D. Use of 3 Tools to Assess Nutrition Risk in the Intensive Care Unit. JPEN J Parenter Enteral Nutr. 2015 Jan;39(1):28-33. DOI: 10.1177/0148607114532135

44. Pablo AM, Izaga MA, Alday LA. Assessment of nutritional status on hospital admission: nutritional scores. Eur J Clin Nutr. 2003 Jul;57:824-31. DOI: 10.1038/ sj.ejcn.1601616

45. Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, et al. Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg. 2013 May;16:612-18. DOI: 10.1093/icvts/ ivs549

46. Devoto G, Gallo F, Marchello C, Racchi O, Garbarini R, Bonassi S, et al. Prealbumin Serum Concentrations as a Useful Tool in the Assessment of Malnutrition in Hospitalized Patients. Clin Chem. 2006 Dec;52(12):2281-5. DOI: 10.1373/clinchem.2006.080366

Revista Romana de Medicina de Laborator

Romanian Journal of Laboratory Medicine

Journal Information

IMPACT FACTOR 2017: 0.400
5-year IMPACT FACTOR: 0.320

CiteScore 2017: 0.31

SCImago Journal Rank (SJR) 2017: 0.144
Source Normalized Impact per Paper (SNIP) 2017: 0.195


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 174 174 14
PDF Downloads 42 42 3