Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.119151
Revised: February 7, 2026
Accepted: March 17, 2026
Published online: July 27, 2026
Processing time: 188 Days and 21.4 Hours
Perioperative serum albumin (ALB) levels affect the outcomes of patients undergoing gastrointestinal surgery. ALB supplementation in patients with low protein levels may therefore be beneficial. However, the specific effects of and optimal levels for serum ALB supplementation remain to be elucidated.
To develop and validate a nomogram for predicting severe complications on the basis of the serum ALB concentration and to establish optimal postoperative serum ALB concentration ranges.
A total of 409 patients who underwent gastrointestinal surgery were randomly divided into a training cohort and a validation cohort. Patients with Clavien-Dindo grade II or higher complications were classified as having severe complications. A nomogram was developed on the basis of the serum ALB concentration to predict the risk of severe complications. Receiver operating characteristic curve, calibration curve and decision curve analysis were performed to validate the nomogram. The χ2 test was used to compare the incidence of severe complications across different ALB ranges.
Logistic regression analysis revealed that the American Society of Anesthesiologists grade, surgery duration, preoperative serum ALB concentration, and age were significant predictors of severe complications. The nomogram developed using these predictors yielded an area under the area under the curve of 0.728 in the training cohort and 0.700 in the validation cohort; the calibration curves demonstrated good consistency between the predicted and observed probabilities in the two cohorts. Decision curve analysis demonstrated that the nomogram provided net benefits in predicting severe complications within threshold probability ranges of 19%-81% and 9%-66% in the two cohorts. Compared to those with relatively low peak postoperative serum ALB concentrations, patients with relatively high concentrations had a significantly lower incidence of severe complications (60.5% vs 40.7%; P = 0.041).
A nomogram that incorporates four clinical characteristics could be valuable for predicting the risk of severe complications. An appropriate range of serum ALB concentrations may be associated with a lower incidence of severe complications.
Core Tip: Serum albumin (ALB) is valuable for reducing the occurrence of severe complications during the perioperative period and for postoperative recovery in patients who undergo gastrointestinal surgery. This study developed a nomogram based on four clinical characteristics, which may be valuable for predicting the risk of severe postoperative complications and could conveniently provide surgeons with early decision-making and timely interventions for high-risk patients. Additionally, compared to those with relatively low peak postoperative serum ALB concentrations, patients with relatively high postoperative serum ALB concentrations had a significantly lower incidence of severe complications. This study provides a valuable reference for perioperative ALB usage.