Hypoalbuminemia

Abstract

Hypoalbuminemia is frequently observed in hospitalized patients and it can be associated with several different diseases, including cirrhosis, malnutrition, nephrotic syndrome and sepsis. Regardless of its cause, hypoalbuminemia has a strong predictive value on mortality and morbidity. Over the years, the rationale for the use of albumin has been extensively debated and the indications for human serum albumin supplementation have changed. As the knowledge of the pathophysiological mechanisms of the pertinent diseases has increased, the indications for intravenous albumin supplementation have progressively decreased. The purpose of this brief article is to review the causes of hypoalbuminemia and the current indications for intravenous administration of albumin. Based on the available data and considering the costs, albumin supplementation should be limited to well-defined clinical scenarios and to include patients with cirrhosis and spontaneous bacterial peritonitis, patients with cirrhosis undergoing large volume paracentesis, the treatment of type 1 hepatorenal syndrome, fluid resuscitation of patients with sepsis, and therapeutic plasmapheresis with exchange of large volumes of plasma. While albumin supplementation is accepted also in other clinical situations such as burns, nephrotic syndrome, hemorrhagic shock and prevention of hepatorenal syndrome, within these contexts it does not represent a first-choice treatment nor is its use supported by widely accepted guidelines.

The Evaluation of Albumin Use in an Iranian University Hospital

“…8 In addition, a normal albumin level prevents the development of edema, providing a balance between hydrostatic and colloid osmotic pressure within vessels. 9 So, it is believed that albumin, featuring water-retention and diuretic properties, can be used to treat edema associated with hypoalbuminemia. 10,11 Although there is undoubtedly some association between edema and low serum albumin, there are many confounding factors which affect the relationship.…”

“…Hypoalbuminemia is defined as a serum albumin concentration < 3.5-4 g/dl and is associated with diverse pathological conditions. 9 It has been shown that hypoalbuminemia is associated with poor outcomes in critically ill patients. 9,12 Nevertheless, several studies have demonstrated that albumin administration in hypoalbuminemic patients had no distinctive effect on mortality or morbidity.…”

“…9 It has been shown that hypoalbuminemia is associated with poor outcomes in critically ill patients. 9,12 Nevertheless, several studies have demonstrated that albumin administration in hypoalbuminemic patients had no distinctive effect on mortality or morbidity. 12 Thus, in many guidelines, decreased serum albumin concentration as a sole diagnosis is not considered a sufficient reason for albumin replacement.…”

Relationship between nutritional status and mortality during the first 2 weeks following treatment for cervical spinal cord injury

“…Because normal levels of plasma proteins, particularly albumin, prevent edema in healthy individuals, hypoalbuminemia may also contribute to edema at the injury site, causing further damage to the respiratory center and other organ systems. 29 Thus, hypoalbuminemia may contribute to mortality by affecting many different processes and worsening complications associated with CSCI. In other conditions, recent scientific literature has also implicated nutritional dysfunction in poor recovery and elevated mortality.…”

Serum Calcium, Albumin and Tumor Stage in Cutaneous Malignant Melanoma

“…27% of serum www.futuremedicine.com albumins were < 4.0 g/dl but only 4.3% of patients had serum albumin <3.5 g/dl (a common cut point for hypoalbuminemia) [19,20]. Serum albumin was significantly lower in stage 4 versus stages 1-3 (p ≤ 0.05; Table 5 & Figure 2B).…”