Haemoglobin and albumin as predictors of survival in patients undergoing major amputation

Abstract

INTRODUCTION: Major lower limb amputation is often the last resort procedure for patients with advanced peripheral artery disease and is associated with substantial mortality. Preoperative biomarkers such as haemoglobin and albumin may provide valuable prognostic information by reflecting oxygen-carrying capacity, nutritional status and systemic inflammation. This study aimed to evaluate the association between preoperative haemoglobin and albumin levels and survival among patients undergoing major lower-limb amputation.

METHODS: A retrospective single-centre study was conducted, including all patients who underwent major lower limb amputation between June 2016 and December 2023 at a tertiary vascular surgery centre. Preoperative haemoglobin and albumin levels were collected from medical records. Patients were stratified according to survival status during follow-up. Independent samples t-tests were used to compare mean values between groups. Cox proportional hazards regression was performed to identify independent predictors of mortality, adjusting for relevant comorbidities.

RESULTS: A total of 585 patients were included (mean age 72±12 years; 66% male), with 61% of patients undergoing transfemoral amputation. During follow-up, 66 patients (11.3%) died. Mean preoperative haemoglobin and albumin levels were significantly higher among survivors (haemoglobin: 10.46 vs 10.06 g/dL p = 0.015; albumin: 3.25 vs 2.94 g/dL p = 0.019. In multivariable Cox regression analysis, cerebrovascular disease (HR 1.50 p = 0.003, congestive heart failure (HR 1.53 p = 0.007), atrial fibrillation (HR 1.49 p = 0.008), and haemoglobin (HR 0.93 per g/dL p = 0.048) were independently associated with mortality. As albumin levels were available for only 99 patients, albumin was analysed separately and showed a strong association with improved survival in univariable analysis. (HR 0.488 p = 0.001).

CONCLUSION: Preoperative haemoglobin is an independent predictor of survival following major lower limb amputation, underscoring the importance of preoperative optimisation and risk stratification. Although albumin demonstrated a significant protective association in univariate analysis, further multivariable validation is required. Incorporating these biomarkers into perioperative assessment protocols may improve the identification of high-risk patients and guide targeted interventions.