Albumin serum as a predictor of prognosis in patients with peripheral artery disease post angioplasty: A Systematic Review and Meta-Analysis
Main Article Content
Keywords
angioplasty, peripheral artery disease, serum albumin
Abstract
Introduction: Peripheral artery disease (PAD) refers to a pathological condition marked by narrowing the artery diameter, the most common cause of atherosclerosis. Serum albumin levels are related to atherosclerosis and increase the risk of hospitalization and death. This study aims to systematically review and conduct a meta-analysis of albumin serum as a predictor of prognosis in patients with peripheral arterial disease (PAD) post-angioplasty.
Methods: Use reputable resources like PubMed, Sage Journal, Lancet, and Science Direct with diverse study designs (randomized controlled trials (RCTs), observational studies, quasi-experimental approaches, and case-control studies) to investigate relevant studies. RevMan software from the Cochrane Collaboration was used to do a meta-analysis. In the meta-analysis, the 95% confidence interval (CI) was utilized as a measure of effect size. The degree of heterogeneity across studies was assessed by applying the Chi-square test and the I² statistic. A fixed-effect model was employed for data synthesis when heterogeneity was minimal (p > 0.1 or I² < 50%), whereas a random-effects model was deemed more appropriate for cases with substantial heterogeneity (I² > 50%). Statistical significance was defined by a p-value less than 0.05.
Results: A thorough three-level screening strategy was used to identify only five articles out of 1499 directly related to the current systematic review. This study shows that hypoalbumin has a greater risk of mortality (OR 4.21 [2.79, 6.34]), a longer length of stay in hospital (MD 3.80 [2.17, 5.44]), and a higher risk of morbidity (OR 5.87 [2.51, 13.72]).
Conclusion: Preoperative hypoalbuminemia is significantly correlated with increased in-hospital mortality and severe postoperative complications in patients undergoing both open and endovascular lower extremity interventions. Given that most procedures are elective, careful evaluation is warranted to postpone elective surgeries until albumin levels are adequately corrected.
References
2. Gerhard-Herman MD, Gornik HL, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12).
3. Saenz-pipaon G, Martinez-aguilar E, Orbe J, et al. The Role of Circulating biomarkers in peripheral arterial disease. Int. J. Mol. Sci. 2021;22(7):1-23.
4. Lin X, Ke F, Chen M. Association of albumin levels with the risk of intracranial atherosclerosis. BMC Neurology. 2023;23(1):1-5.
5. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.
6. Bath J, Smith JB, et al. Complex relationship between low albumin level and poor outcome after lower extremity procedures for peripheral artery disease. J Vasc Surg. 2021;73(1):200–9.
7. Süleymanoğlu M, Burak C, Gümüşdağ A, Çap M, Şenol A, Hamideyin Ş, et al. Prognostic value of C-reactive protein to albumin ratio for long-term outcomes of patients with peripheral arterial disease underwent endovascular treatment. Vascular. 2022;30(3):481–9.
8. Peacock, M. R., Farber, A., Eslami, M. H., Kalish, J. A., Rybin, D., Doros, G., et al. Hypoalbuminemia Predicts perioperative Morbidity and Mortality after Infrainguinal Lower Extremity Bypass for critical Limb Ischemia. Annals of Vascular Surg. 2017;41:169-175.
9. Thongprayoon, C, Cheungpasitporn, W, et al. Impacts of admission serum albumin levels on short-term and long-term mortality in hospitalized patients. 2020;113(6):3-35.
10. Westfall, J. C., Cheng, T. W., Farber, A., Jones, D. W., Eslami, M. H., Kalish,J. A., et al. Hypoalbuminemia Predicts Increased Readmission and Emergency Department Visits After Lower Extremity Bypass. Vascular and Endovascular Surgery. 2019;53(8):629–635.
11. Abola MTB, Golledge J, Miyata T, Rha SW, Yan BP, Dy TC, et al. Asia-Pacific Consensus Statement on the Management of Peripheral Artery Disease: A Report from the Asian Pacific Society of Atherosclerosis and Vascular Disease Asia-Pacific Peripheral Artery Disease Consensus Statement Project Committee. J Atheroscler Thromb. 2020;27(8):809–907.
12. Kremers B, Wübbeke L, Mees B, ten Cate H, Spronk H, ten Cate-Hoek A. Plasma Biomarkers to Predict Cardiovascular Outcome in Patients With Peripheral Artery Disease. Arterioscler Thromb Vasc Biol. 2020;40(9):2018–32.
13. Pan D, Guo J, Su Z, Meng W, Wang J, Guo J, et al. Association of prognostic nutritional index with peripheral artery disease in US adults: a cross-sectional study. BMC Cardiovasc Disord. 2024;24(1):133.
14. Kato T, Ueki Y, Minamisawa M, Miura T, Oyama Y, Hashizume N, et al. Association between complete revascularization of the coronary artery and clinical outcomes in peripheral artery disease: a sub-analysis of the I-PAD Nagano registry. Heart Vessels. 2023;38(8):1001–8.
15. Mizobuchi K, Jujo K, Minami Y, Ishida I, Nakao M, Hagiwara N. The Baseline Nutritional Status Predicts Long-Term Mortality in Patients Undergoing Endovascular Therapy. Nutrients. 2019;11(8).
16. Ding C, Wang H, Huang X, Hu L, Shi Y, Li M, et al. Association between serum albumin and peripheral arterial disease in hypertensive patients. J Clin Hypertens. 2020;22(12):2250–7.
17. Chahrour MA, Kharroubi H, Tannir AHA, et al. Hypoalbuminemia is Associated with Mortality in Patients Undergoing Lower Extremity Amputation. Annals of Vascular Surg. 2021;77:138-145.
18. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ocek AH, Koseoglu C, et al. Usefulness of serum albumin concentration to predict high coronary SYNTAX score and in-hospital mortality in patients with acute coronary syndrome. Angiology. 2016;67(1):34–40.
19. Cheng CW, Lee CW, Chien SC, Yeh HI, Chen CY. Serum Albumin was Associated with a Long-Term Cardiovascular Mortality among Elderly Patients with Stable Coronary Artery Disease. Acta Cardiol Sin. 2024;40(1):87–96.
20. Gupta, D., & Lis, C. G. Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature. Nutrition Journal. (2010);9(1): 1–16.