A prospective cohort study in a European centre

The results from this prospective study indicate that an early rapid drop in postoperative serum albumin is a marker of surgical stress and could be an early predictor of patients at risk of postoperative complications.

There has been increasing interest in identifying biomarkers that track the stress response to surgery (Thorell et al., 1999; Kohl & Deutschman, 2006; Amar et al., 2007; Mantziari et al., 2015), and in their potential to identify patients at risk of developing postoperative complications.

Two such biomarkers already identified include C-reactive protein and procalcitonin. Although they are routinely used biomarkers in clinical practice, their usefulness is limited by their slow kinetics (Facy et al., 2016; Giaccaglia et al., 2016) with both markers only becoming useful about the fourth day after surgery.

In contrast, serum albumin is rapidly downregulated by inflammatory signals on the first postoperative day (Mantziari et al., 2015; Hübner et al., 2016;), with preliminary data suggesting an association between a rapid postoperative drop and outcomes after oesophageal, oral cancer, abdominal pancreatic, liver resection/transplant and cardiac surgeries (Ryan et al., 2007; Lee et al., 2011; 2015; Fujiwara et al., 2015; Sang et al., 2015; Labgaa et al., 2016).

This prospective study provided a head-to-head comparison of serum albumin with C-reactive protein and procalcitonin, with the aim of testing postoperative serum albumin drop as a marker of surgical stress and an early predictor of clinical outcomes (Figure 1).

Successful preoperative measures already exist to attenuate the stress response to surgery include immunonutrition, enhanced recovery programmes and high-dose glucorticoids (Ljungqvist et al., 2005; de la Motte et al., 2014; Cerantola et al., 2015; Carli, 2015). Further research is needed to determine whether these options might also be effective postoperatively in calming the stress response once it has been triggered.