Preoperative Albumin Infusion Reduced Pulmonary Complications in Elderly Patients With Hypoalbuminemia Undergoing Cardiac Surgery: A Single-Center, Randomized, Double-Blind, Controlled Pilot Trial

Abstract

Hypoalbuminemia is a recognized risk factor for postoperative pulmonary complications (PPCs), but whether preoperative albumin infusion improves pulmonary outcomes after cardiac surgery remains unclear. In this single-center, randomized, double-blind, controlled pilot trial (ChiCTR2300076609), 80 elderly patients with preoperative albumin concentrations <40 g/L who underwent elective cardiac surgery with cardiopulmonary bypass were randomly assigned to receive 100 mL of 20% albumin (40 patients) or saline before surgery (40 patients). The primary outcomes were PPC severity and incidence during hospitalization, and perioperative immune cell changes were also explored. All randomized participants completed the trial. Compared with the controls, the patients in the albumin group had lower PPC severity (median [IQR], 1 [1–2] vs. 2 [2–3]; mean difference, −0.75; 95% CI, −1.15 to −0.35; p = 0.001) and a lower incidence of PPCs (30% vs. 57.5%; risk difference, −0.275; 95% CI, −0.48 to −0.07; p = 0.013). Additionally, the Th17 cell proportion and γδTreg cell proportion were significantly decreased and increased, respectively, in the albumin group after surgery (p < 0.001). These findings suggest that preoperative albumin supplementation may reduce PPC risk and modulate immune responses, warranting confirmation in larger multicenter trials.

Keywords

albumin / cardiopulmonary bypass / elderly patients / inflammatory cells / postoperative pulmonary complications

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