Albumin as a predictor in a nomogram for severe complications following gastrointestinal surgery and how to manage it

Table 1 Comparison of characteristics between training cohort and validation cohort, n (%)/median (interquartile range)/mean± SD

Characteristics	Training cohort (n = 286)	Validation cohort (n = 123)	P value
Age (years)	65.00 (57.00-72.00)	65.00 (59.00-71.00)	0.784
Sex			0.672
Male	183 (63.99)	76 (61.79)
Female	103 (36.01)	47 (38.21)
American Society of Anesthesiologists grade			0.430
Low	203 (70.98)	92 (74.80)
High	83 (29.02)	31 (25.20)
Operation			0.823
Laparoscopy	164 (57.34)	72 (58.54)
Laparotomy	122 (42.66)	51 (41.46)
Surgical duration (minutes)	264.00 (210.00-315.00)	252.00 (193.00-317.00)	0.925
Preoperative total bilirubin (μmol/L)	11.50 (8.70-14.60)	11.90 (8.80-15.50)	0.497
Preoperative alanine aminotransferase (U/L)	14.00 (10.00-20.00)	13.00 (9.00-21.00)	0.869
Preoperative aspartate aminotransferase (U/L)	16.00 (14.00-20.00)	17.00 (14.00-21.00)	0.480
Preoperative gamma-glutamyl transferase (U/L)	19.00 (14.00-30.00)	18.00 (13.00-25.00)	0.224
Preoperative albumin (g/L)	37.16 ± 4.22	37.88 ± 4.35	0.117

Table 2 Stratified multivariable logistic regression analysis of preoperative albumin on severe complications

Characteristics	Univariable logistic regression		Multivariable logistic regression
	OR (95%CI)	P value	OR (95%CI)	P value
Age (years)	1.003 (1.014-1.053)	0.001	1.019 (0.997-1.041)	0.091
Sex
Male	Reference		-
Female	1.074 (0.718-1.607)	0.729	-
American Society of Anesthesiologists grade
Low	Reference		Reference
High	2.608 (1.669-4.075)	< 0.001	1.715 (1.010-2.912)	0.046
Operation
Laparoscopy	Reference		Reference
Laparotomy	1.695 (1.141-2.519)	0.009	1.356 (0.863-2.130)	0.187
Surgical duration (minutes)	1.005 (1.003-1.007)	< 0.001	1.005 (1.003-1.008)	< 0.001
Preoperative total bilirubin (μmol/L)	1.012 (0.987-1.038)	0.341	-
Preoperative alanine aminotransferase (U/L)	1.001 (0.990-1.012)	0.893	-
Preoperative aspartate aminotransferase (U/L)	1.012 (0.995-1.029)	0.182	-
Preoperative gamma-glutamyl transferase (U/L)	1.002 (0.998-1.005)	0.355	-
Preoperative albumin (g/L)
(30, 35)	3.302 (1.701-5.405)	< 0.001	2.223 (1.192-4.415)	0.012
(35, 40)	1.234 (0.732-2.079)	0.430	1.021 (0.589-1.770)	0.942
(40, 45)	Reference		Reference

OR: Odds ratio.

Table 3 Stratified multivariable logistic regression analysis of lowest postoperative albumin levels within 5 days on severe complications

Characteristics	Univariable logistic regression		Multivariable logistic regression
	OR (95%CI)	P value	OR (95%CI)	P value
Age (years)	1.003 (1.014-1.053)	0.001	1.022 (1.000-1.043)	0.047
Sex
Male	Reference		-
Female	1.074 (0.718-1.607)	0.729	-
American Society of Anesthesiologists grade
Low	Reference		Reference
High	2.608 (1.669-4.075)	< 0.001	2.085 (1.253-3.467)	0.005
Operation
Laparoscopy	Reference		Reference
Laparotomy	1.695 (1.141-2.519)	0.009	1.203 (0.775-1.886)	0.410
Surgical duration (minutes)	1.005 (1.003-1.007)	< 0.001	1.004 (1.002-1.007)	< 0.001
Preoperative total bilirubin (μmol/L)	1.012 (0.987-1.038)	0.341	-
Preoperative alanine aminotransferase (U/L)	1.001 (0.990-1.012)	0.893	-
Preoperative aspartate aminotransferase (U/L)	1.012 (0.995-1.029)	0.182	-
Preoperative gamma-glutamyl transferase (U/L)	1.002 (0.998-1.005)	0.355	-
Lowest postoperative albumin within 5 days (g/L)
(25, 30)	3.066 (1.666-5.644)	< 0.001	2.331 (1.214-4.476)	0.011
(30, 35)	2.256 (1.328-3.832)	0.003	1.725 (0.978-3.043)	0.060
(35, 40)	Reference		Reference

OR: Odds ratio.