Colectomy in patients with liver disease: albumin-bilirubin score accurately predicts outcomes.

Autor:	Kling SM; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States., Taylor GA; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States., Peterson NR; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States., Patel T; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States., Fagenson AM; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States., Poggio JL; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States., Ross HM; Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey, United States., Pitt HA; Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States., Lau KN; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States., Philp MM; Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, United States; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States. Electronic address: matthew.philp@tuhs.temple.edu.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2024 Jun; Vol. 28 (6), pp. 843-851. Date of Electronic Publication: 2024 Mar 24.
DOI:	10.1016/j.gassur.2024.03.012
Abstrakt:	Background: Patients with liver disease undergoing colectomy have higher rates of complications and mortality. The Albumin-Bilirubin score is a recently developed system, established to predict outcomes after hepatectomy, that accounts for liver dysfunction. Methods: All patients undergoing colectomy were identified in the 2015-2018 American College of Surgeons National Surgical Quality Improvement Program colectomy-targeted database. Demographics and outcomes were compared between patients with Albumin-Bilirubin Grade 1 vs. 2/3. Multivariable regression was performed for outcomes including colorectal-specific complications. Areas under the receiver operative characteristic curves were calculated to determine accuracy of the Albumin-Bilirubin score. Results: Of 86,273 patients identified, 48% (N = 41,624) were Albumin-Bilirubin Grade 1, 45% (N = 38,370) Grade 2 and 7% (N = 6,279) Grade 3. Patents with Grade 2/3 compared to Grade 1 had significantly increased mortality (7.2% vs. 0.9%, p < 0.001) and serious morbidity (31% vs. 12%, p < 0.001). Colorectal-specific complications including anastomotic leak (3.7% vs. 2.8%, p < 0.001) and prolonged ileus (26% vs. 14%, p < 0.001) were higher in patients with Grade 2/3. Grade 2/3 had increased risk of mortality (odds ratio 3.07, p < 0.001) and serious morbidity (1.78, p < 0.001). Albumin-Bilirubin had excellent accuracy in predicting mortality (area under the curve 0.81, p < 0.001) and serious morbidity (0.70, p < 0.001). Conclusion: Albumin-Bilirubin is easily calculated using only serum albumin and total bilirubin values. Grade 2/3 is associated with increased rates of mortality and morbidity following colectomy. Albumin-Bilirubin can be applied to risk-stratify patients prior to colectomy. Competing Interests: Declaration of competing interest The authors declare no competing interests. (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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