الفهرس 
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Abstract
Malnutrition is a common problem in the hospital setting that often goes unrecognized by healthcare providers. Investigators have reported that malnutrition occurs in 30% to 55% of hospitalized patients, resulting in an adverse economic impact (Kruizenga et al, 2005). Hypoalbuminemia (serum albumin less than 35 g/L) often reflects malnourishment (Fuhrman et al 2004). Because the nutritional status impact on postoperative clinical outcome, early recognition of malnutrition or risk to malnutrition must be investigated. Early malnutrition recognition allows to an appropriate nutritional therapy planning, which might be able to prevent, interrupt or reverse the inadequate nutritional status and to avoid post-surgical complications (Bragagnolo et al., 2009). Nutritional assessment should be capable to predict clinical outcome or prognosis, and, at the same time, must be low-cost and fast to perform (Thieme et al. 2013). Serum albumin is a good and simple predictor of surgical risk and has a close correlation with the degree of malnutrition (Fuhrman et al, 2004). It has the highest positive predictive value of all the nutritional assessment methods for predicting associated complications and mortality (Kyle et al., 2003). Albumin level below 30 g/L helps identify a high-risk surgical population. Although the causes of low albumin are multifactorial, identification of this subset of patients and aggressive optimization of nutritional status preoperatively or using alternative treatment strategies for patients who are extremely high risk for open surgery may improve surgical outcomes in this population (Shitanshu et al., 2013). This is a prospective observational study that was carried out in the Intensive Care Unit of South Egypt Cancer Institute (SECI-ICU), Assiut University, Assiut, Egypt. After Institutional Ethics Committee approval and written informed consent, 40 patients underwent elective major oncological surgery were included in the study. Preoperative serum albumin was measured and these patients were divided according to their serum albumin level into two groups. group I with serum albumin >35 g/L and group II with serum albumin ≤ 35 g/L. After surgery, patients were monitored daily for major postoperative complications. The presence of organ dysfunction was assessed using the sequential organ failure assessment (SOFA) score recorded on the day of admission to the ICU and every 48 hours until discharge. The length of stay in the ICU was measured as the number of days from admission to the ICU until discharge from the ICU. Laboratory investigations included; complete blood picture, arterial blood gas, liver function test, kidney function tests and interluekin 1 level. The result of our study showed that postoperative complications including; pneumonia/ respiratory tract infection, respiratory failure, ARDS, heart failure, renal failure, major thromboembolic events, wound infection /dehiscence, fistula, sepsis and MODS were higher in number and percentage in group II (serum albumin ≤ 35g/ L) compared to group I (serum albumin >35 g/L). When using SOFA score as a tool for assessing the degree of organ dysfunction, preoperative hypoalbuminemia (serum albumin ≤ 35g/ L) was associated with significant higher scores in all follow up days. Also, the length of ICU stay was significantly longer in hypoalbuminemic patients (serum albumin ≤ 35g/ L) when compared to non-hypoalbuminemic patients (serum albumin > 35 g/L). Furthermore, preoperative hypoalbuminemia was associated with a significant increase in the level of IL1 and neutrophilic count in all follow up days. On the other hand, total lymphocytic count didn’t show statistically insignificant difference in all follow up days. In conclusion, the current study revealed that preoperative hypoalbuminemia increases the risk of postoperative complications and length of stay in ICU after major cancer surgery, as such, accounts for high proportion of ICU budget. Some limitations are present in this study, including lack of follow up of patients after discharge from ICU and from hospital as some postoperative complications might manifest later after discharge and these data were not evaluated. Also, small number of patients studied in a single institution, limiting the generalization of the conclusion. We believe that the results of this study give reasons for raising attention about using serum albumin level as a simple and low-cost prognostic tool to predict the risk of adverse surgical outcome and consequently, decreasing the incidence of postoperative complications and ICU stay.