Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh
Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acute kidney injury (AKI), after off-pump coronary artery bypass (OPCAB) surgery. This study aimed to assess the relationship between preoperative serum albumin levels and early postoperative renal injury. Methods: This prospective comparative cross-sectional study was conducted from August 2019 to February 2021 at the National Heart Foundation Hospital & Research Institute, Bangladesh. It included 160 adult patients with normal preoperative renal function undergoing OPCAB. Patients were divided into two groups: Group A (serum albumin ≥ 4.0 gm/dl) and Group B (serum albumin < 4.0 gm/dl). AKI was categorized based on the Acute Kidney Injury Network (AKIN) criteria within the first 48 hours of post-surgery. Multivariate regression analyses evaluated the association between preoperative serum albumin levels and postoperative AKI. Results: Preoperative serum albumin was significantly different between groups (Group A: 4.21 ± 0.05 gm/dl, Group B: 3.69 ± 0.04 gm/dl, p = 0.028). Group B had a higher incidence of hypertension (71.25% vs. 51.25%, p < 0.05). Postoperative blood loss and transfusion requirements were significantly higher in Group B. Serum creatinine levels on the 1st and 3rd postoperative days were higher in Group B (p < 0.05), although levels equalized by the 7th day. Postoperative AKI occurred in 18.75% of Group A and 36.25% of Group B. Multivariate regression indicated that low preoperative serum albumin is an independent risk factor for postoperative AKI (p = 0.012, OR = 1.815, CI: 0.675 - 1.162). Conclusion: Preoperative serum albumin level is a valuable predictor of postoperative renal function. Ensuring high normal serum albumin levels before surgery can help minimize the risk of postoperative AKI.
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