Role of preoperative bilirubin/albumin Ratio in prediction of sepsis and mortality in emergent colorectal surgery

BACKGROUND: Sepsis comprises a spectrum of illnesses that confer great morbidity and mortality in surgical patients. Tremendous efforts are channeled towards timely diagnosis and control of sepsis. Few studies have reported on the independent association of bilirubin or albumin in the postoperative setting for prediction of complications. The purpose of this study was to assess the role of Bilirubin/Albumin Ratio (B-A Ratio) in the preoperative prediction of postoperative sepsis and mortality in non-septic patients undergoing emergent colorectal surgery.METHODS: This is a retrospective study that used the NSQIP database for the years 2005-2017 to analyze data on patients who underwent emergent colorectal operations. Multivariate regression analysis was done to calculate the predictive utility of the B-A Ratio for postoperative outcomes, namely sepsis and mortality. Cox regression was utilized to assess hazard ratio of mortality based on a cutoff value of 0.23 for the B-A Ratio.RESULTS: We analyzed 23,822 patients with no identifiable preoperative sepsis who underwent emergent colorectal operations. We compared the basic demographic characteristics with respect to a cutoff value of 0.23 for B-A Ratio. Using logistic regression, the adjusted Odds Ratio for sepsis and mortality based on the cutoff value of 0.23 for the B-A Ratio was 1.26 (1.15-1.38) and 1.47 (1.32-1.66) respectively. In addition, respiratory and thromboembolic complications showed OR of 1.25 (1.14-1.37) and 1.20 (1.02-1.4), respectively. The Hazard Ratio for patients with Bilirubin/Albumin Ratio less than 0.23 was lower than those with a Bilirubin/Albumin Ratio greater than 0.23 (HR=1.31 P<0.0001).CONCLUSIONS: Patients with a B-A Ratio more than 0.23 have an increase in the odds of sepsis, mortality and postoperative complications. The cumulative survival was higher for patients with a preoperative B-A Ratio below the cutoff point.