Serum Albumin: A Promising Biomarker to Anticipate Postoperative Complications

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We have read the article of Ge et al1 with particular interest. This study tested the predictive value of postoperative decrease of serum albumin (SA) for adverse outcomes in a retrospective cohort of colorectal surgery. Of note, the concept suggesting that Δalbumin is a predictor of complications is not exactly novel.2–4 It is, however, critical to validate the role of Δalbumin, particularly because it is an easy and inexpensive biomarker, unlike other more complex ones.5,6 The authors established that a 15% reduction in SA within 2 postoperative days was an independent predictor of complications.
We address several points. First, did the authors test the predictive value of Δalbumin at postoperative day 1 because available data suggested that Δalbumin was already indicative at postoperative day 1?2,4 Second, did the authors compare the performance of absolute vs relative Δalbumin? In other words, does a reduction of 15% display a significantly better performance than, for example, 6 g/L? If not, one may assume that an absolute value may be easier to implement in clinical practice.
The authors also concluded that whether the conclusion of the current study could be extrapolated to other abdominal procedures, such as gastrectomy or esophagectomy resections, is unknown. Importantly, our group recently published a prospective study including all types of major abdominal surgery that confirmed that an early postoperative decrease of SA correlated with complications and length of stay.7 Strikingly, the protocol of our prospective study registered in clinicaltrials.gov (NCT02356484) in February 2015 shows surprising similarities with the retrospective study published in Diseases of the Colon & Rectum Ge et al.
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