Preoperative Neutrophil-to-Albumin Ratio and Post-Induction Hemodynamic Vulnerability in Major Oncologic Surgery

NCT07804706 | Recruiting

• 1 other identifier: 2026-08/185
• Study Type: observational
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

This prospective observational study aims to evaluate whether the preoperative neutrophil percentage-to-albumin ratio (NPAR) is associated with post-induction hemodynamic vulnerability in adult patients undergoing elective major oncologic surgery under general anesthesia. NPAR will be calculated from routine preoperative laboratory results by dividing the neutrophil percentage by the serum albumin level. No additional laboratory tests, medications, invasive procedures, or changes in anesthesia management will be performed for the purposes of the study. Demographic characteristics, preoperative laboratory values, anesthetic data, and hemodynamic measurements will be recorded prospectively. Hemodynamic status will be evaluated during the period between induction of general anesthesia and surgical incision, with a maximum observation period of 20 minutes. Vasopressor use and administered doses will also be recorded. The study will assess the ability of preoperative NPAR to identify patients who may be more susceptible to early hemodynamic instability following induction of general anesthesia.

Conditions

Hemodynamic Instability; Post-induction Hypotension (PIH)

Keywords

Neutrophil Percentage-to-Albumin Ratio; Post-Induction Hypotension; Hemodynamic Vulnerability; Major Oncologic Surgery

Outcome Measures

Primary Outcomes (1)

• Occurrence of Post-Induction Hemodynamic Vulnerability

  Post-induction hemodynamic vulnerability will be defined as the occurrence of at least one mean arterial pressure (MAP) measurement ≤65 mmHg after induction of general anesthesia and before surgical incision. MAP will be assessed using standard intraoperative hemodynamic monitoring.

  From induction of general anesthesia to surgical incision, up to 20 minutes

Study Arms (1)

Major Oncologic Surgery Cohort

Adult patients undergoing elective major oncologic surgery under general anesthesia will be prospectively enrolled. Preoperative neutrophil percentage-to-albumin ratio (NPAR) will be calculated from routine laboratory measurements. Hemodynamic data will be recorded from induction of general anesthesia until surgical incision, for a maximum of 20 minutes, to evaluate post-induction hemodynamic vulnerability. No research-specific intervention or modification of routine anesthetic management will be performed.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

The study population will consist of adult patients aged 18 years or older who are scheduled to undergo elective major oncologic surgery under general anesthesia. Eligible participants must have available preoperative complete blood count and serum albumin measurements and undergo standard intraoperative hemodynamic monitoring. Patients will be enrolled consecutively at the study center. Individuals undergoing emergency surgery or presenting with preoperative hemodynamic instability, vasopressor or inotropic support, sepsis or active infection, hematologic malignancy, advanced cardiac, renal, or hepatic failure, pregnancy, or missing laboratory data will be excluded.

You may qualify if:

• Age 18 years or older
• Scheduled for elective major oncologic surgery
• Undergoing surgery under general anesthesia
• Availability of preoperative complete blood count and serum albumin -measurements
• Standard hemodynamic monitoring
• Provision of written informed consent for participation in the study

You may not qualify if:

• Age younger than 18 years
• Emergency surgery
• Preoperative hemodynamic instability
• Preoperative vasopressor or inotropic support
• Sepsis or active infection
• Hematologic malignancy
• Advanced cardiac, renal, or hepatic failure
• Pregnancy
• Missing preoperative laboratory data -Inability to complete the 20-minute post-induction evaluation period-

Sponsors & Collaborators

• Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital: lead

Study Sites (1)

Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital

Ankara, Yeni̇mahalle, Turkey (Türkiye)

RECRUITING

Related Publications (3)

• Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999 Feb 11;340(6):448-54. doi: 10.1056/NEJM199902113400607. No abstract available.

  PMID: 9971870 BACKGROUND

• Maheshwari K, Turan A, Mao G, Yang D, Niazi AK, Agarwal D, Sessler DI, Kurz A. The association of hypotension during non-cardiac surgery, before and after skin incision, with postoperative acute kidney injury: a retrospective cohort analysis. Anaesthesia. 2018 Oct;73(10):1223-1228. doi: 10.1111/anae.14416. Epub 2018 Aug 24.

  PMID: 30144029 BACKGROUND

• Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2007 Aug;107(2):213-20. doi: 10.1097/01.anes.0000270724.40897.8e.

  PMID: 17667564 BACKGROUND

Central Study Contacts

Mustafa Kemal SAHIN, M.D

CONTACT

+5075800976; Mksahin@msn.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: September 1, 2026
• First Posted: September 4, 2026
• Study Start: September 1, 2026
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 15, 2026
• Last Updated: September 9, 2026

Record last verified: 2026-09

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)