George A Taylor1, Alexander M Fagenson1, Lindsay E Kuo1, Henry A Pitt2, Kwan N Lau3. 1. Department of Surgery, Lewis Katz School of Medicine Temple University Hospital, Philadelphia, PA. 2. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ. 3. Department of Surgery, Lewis Katz School of Medicine Temple University Hospital, Philadelphia, PA. Electronic address: kwannang.lau@tuhs.temple.edu.
Abstract
BACKGROUND: The Albumin-Bilirubin score (ALBI) has recently been shown to have increased accuracy in predicting post-hepatectomy liver failure and mortality compared to the Model for End Stage Liver Disease (MELD). However, the utilization of ALBI as a predictor of postoperative mortality for other surgical procedures has not been analyzed. The aim of this study is to measure the predictive power of ALBI compared to MELD-sodium (MELD-Na) across a wide range of surgical procedures. STUDY DESIGN: Patients undergoing cardiac, pulmonary, esophageal, gastric, gallbladder, pancreatic, splenic, appendix, colorectal, adrenal, renal, hernia, and aortic surgery were identified in the 2015-2018 ACS-NSQIP database. Patients with missing laboratory data were excluded. Univariable analysis and receiver operator characteristic (ROC) curves were performed for 30-day mortality and morbidity. Areas Under the Curves (AUC) were calculated to validate and compare the predictive abilities of ALBI and MELD-Na. RESULTS: Of 258,658 patients, the distribution of ALBI Grade 1, 2, 3 were 51%, 42%, and 7%, respectively. The median MELD-Na was 7.50 (IQR: 6.43-9.43). The overall 30-day mortality rate was 2.7%, while overall morbidity was 28.6%. Increasing ALBI Grade was significantly associated with mortality (ALBI Grade 2 OR 5.24, p<0.001; ALBI Grade 3 OR 25.6, p<0.001) and morbidity (ALBI Grade 2: OR 2.15, p<0.001; ALBI Grade 3: OR 6.12, p<0.001). On ROC analysis, ALBI outperformed MELD-Na with increased accuracy in several operations. CONCLUSION: ALBI score predicts mortality and morbidity across a wide spectrum of surgical procedures. When compared to MELD-Na, ALBI more accurately predicts outcomes in patients undergoing pulmonary, elective colorectal, and adrenal operations.
BACKGROUND: The Albumin-Bilirubin score (ALBI) has recently been shown to have increased accuracy in predicting post-hepatectomy liver failure and mortality compared to the Model for End Stage Liver Disease (MELD). However, the utilization of ALBI as a predictor of postoperative mortality for other surgical procedures has not been analyzed. The aim of this study is to measure the predictive power of ALBI compared to MELD-sodium (MELD-Na) across a wide range of surgical procedures. STUDY DESIGN:Patients undergoing cardiac, pulmonary, esophageal, gastric, gallbladder, pancreatic, splenic, appendix, colorectal, adrenal, renal, hernia, and aortic surgery were identified in the 2015-2018 ACS-NSQIP database. Patients with missing laboratory data were excluded. Univariable analysis and receiver operator characteristic (ROC) curves were performed for 30-day mortality and morbidity. Areas Under the Curves (AUC) were calculated to validate and compare the predictive abilities of ALBI and MELD-Na. RESULTS: Of 258,658 patients, the distribution of ALBI Grade 1, 2, 3 were 51%, 42%, and 7%, respectively. The median MELD-Na was 7.50 (IQR: 6.43-9.43). The overall 30-day mortality rate was 2.7%, while overall morbidity was 28.6%. Increasing ALBI Grade was significantly associated with mortality (ALBI Grade 2 OR 5.24, p<0.001; ALBI Grade 3 OR 25.6, p<0.001) and morbidity (ALBI Grade 2: OR 2.15, p<0.001; ALBI Grade 3: OR 6.12, p<0.001). On ROC analysis, ALBI outperformed MELD-Na with increased accuracy in several operations. CONCLUSION:ALBI score predicts mortality and morbidity across a wide spectrum of surgical procedures. When compared to MELD-Na, ALBI more accurately predicts outcomes in patients undergoing pulmonary, elective colorectal, and adrenal operations.
Authors: Giovanni Marasco; Luigina Vanessa Alemanni; Antonio Colecchia; Davide Festi; Franco Bazzoli; Giuseppe Mazzella; Marco Montagnani; Francesco Azzaroli Journal: J Clin Med Date: 2021-05-08 Impact factor: 4.241