Leakage of albumin in major abdominal surgery

Norberg, Åke; Rooyackers, Olav; Segersvärd, Ralf; Wernerman, Jan

doi:10.1186/s13054-016-1283-8

Cited by 45 publications

(50 citation statements)

References 28 publications

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“…Both volunteers [15] and cholecystitis patients [6] have been investigated previously. The temporal pattern of plasma albumin concentration in patients undergoing pancreatic resection fully reproduced a previous report [18]. The impact on the de-novo synthesis rate during anesthesia and surgery is less well studied, however.…”

Section: Discussionsupporting

confidence: 81%

“…1). Further on, 48 hours postoperatively, with a similar decrease in plasma albumin concentration, the TER is back to normal [5, 18]. Nevertheless, our data provide new information regarding the relation between albumin plasma concentration and the TER in surgical trauma.…”

Section: Discussionmentioning

confidence: 64%

“…The TER reflects the escape of isotopic label from plasma, but the return of albumin to plasma, mainly through the lymphatic system, is not easy to quantify by existing techniques in human subjects. Some information on this possible mismatch between escape and return may be gained by utilizing calculations of fluid and albumin balances [18]. …”

Section: Discussionmentioning

confidence: 99%

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Simultaneous assessment of the synthesis rate and transcapillary escape rate of albumin in inflammation and surgery

et al. 2016

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BackgroundBetter knowledge of albumin kinetics is needed to define the indications for albumin use in clinical practice. This study involved two approaches: the synthesis rate and transcapillary escape rate of albumin were measured simultaneously at different levels of plasma albumin concentration in relation to acute inflammation and surgery; and two different tracers were compared to determine plasma volume and the transcapillary escape rate.MethodsHealthy volunteers (n = 10), patients with acute inflammatory abdominal disease (n = 10), and patients undergoing elective pancreatic resection (n = 10) were studied. The albumin synthesis rate was measured by the incorporation of deuterium-labeled phenylalanine. Plasma volume and the transcapillary escape rate were assessed using 123I-labeled and 125I-labeled albumin.ResultsA 50 % elevated de-novo albumin synthesis rate was seen in patients with acute inflammation and marked hypoalbuminemia, while patients with marginal hypoalbuminemia before the start of surgery had a normal albumin synthesis rate. The transcapillary escape rate was elevated intraoperatively during the reconstructive phase of pancreatic surgery, when plasma albumin was decreased but stable. In acute inflammation with marked hypoalbuminemia, the transcapillary escape rate was no different from normal. 123I-labeled and 125I-labeled albumin were found exchangeable for plasma volume determinations, but could be used only in groups of patients for the transcapillary escape rate.ConclusionsThis observational study illustrates the limited information contained in albumin plasma concentrations to reflect albumin kinetics. On the contrary, single measurements of the synthesis rate and/or transcapillary escape rate of albumin obviously cannot explain the plasma level of albumin or the changes seen in plasma albumin concentration.Trial registration www.clinicaltrials.gov, study number NCT01686776. Registered 13 September 2012.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Simultaneous assessment of the synthesis rate and transcapillary escape rate of albumin in inflammation and surgery

et al. 2016

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“…This may be described as the transcapillary escape rate, which is estimated by the elimination of radioactivity after an injection of 125 I‐albumin. For healthy participants, the basal state of the transcapillary escape rate (and consequently the reappearance rate in a steady state) is on the magnitude of 5%/h, while the de novo fractional synthesis rate of serum albumin in the postabsorptive state is in the range of 5%–10%/d 16 , 17 . If the synthesis rate is measured in healthy participants in the postabsorptive state and the transcapillary escape rate is measured in parallel, the decay of radioactivity in plasma as well as the cumulated excretion of 125 I‐albumin into the urine may estimate both the synthesis and degradation of serum albumin.…”

Section: Basic Physiology Of Feedingmentioning

confidence: 99%

Assessment of Protein Turnover in Health and Disease

et al. 2017

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To identify protein requirements, it is necessary to be familiar with basic physiology, practical methods, and dose response of protein delivery. This review evaluates available methodology, with emphasis on the limitations of existing techniques most often related to the underlying assumption. Historically, nitrogen balance has been the dominating technique. It is still the gold standard, although there are considerable problems related to the underlying assumptions to have reliable readings. When minimal requirements needed to be defined, the indicator amino acid oxidation technique came into practice. In situations of longer term steady states, it serves a purpose. In situations of disease or in aging, it has proven to be more problematic. More recently, whole-body protein turnover measurements have shown to be useful in situations where the underlying assumptions for the other techniques are not possible to meet.

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“…Studies of albumin demonstrate an almost 50% reduction in plasma concentration within a few hours after the start of a major surgical procedure, attributable to a number of interventions and physiological perturbations [1, 2]. Still, the albumin synthesis rate is unaltered on postoperative day two when compared to the preoperative rate, despite the dramatic decrease in plasma concentration [3].…”

Section: Introductionmentioning

confidence: 99%

Repeated quantitative measurements of De Novo synthesis of albumin and fibrinogen

Dumitrescu¹,

Komaromi²,

Rooyackers³

et al. 2017

PLoS ONE

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The possibility of using two different isotopomers, for the incorporation of isotopically labeled amino acids, was explored to enable longitudinal studies of de novo synthesis of two export liver proteins, albumin and fibrinogen. The agreement of the synthesis rates between the two different labels was evaluated along with the reproducibility of repeated experiments using different time intervals. Healthy volunteers were studied in a standardized fed state. Protocol A (n = 10) involved two measurements 48 hours apart. Protocol B (n = 6) involved three measurements at baseline and five hours and then seven days after the initial measurement. De novo synthesis of albumin and fibrinogen by the incorporation of D5-phenylalanine or D8-phenylalanine were measured using the flooding dose technique. Albumin and fibrinogen were isolated from plasma using standard techniques. Fractional and absolute synthesis rates were calculated. Repeated measurements employing the two isotoptomers showed good agreement for albumin fractional synthesis rate after 48 hours (p = 0.92) and after 7 days (p = 0.99), with a coefficient of variation of 5.9% when using the same isotopic label. For fibrinogen, the coefficient of variation for the fractional synthesis rate employing the same isotopic label was 16.6%. Repeated measurements after 48 hours and seven days showed less agreement although there was no statistical difference (P = 0.32 and P = 0.30 respectively). Repeated measurement after five hours showed a statistical significant difference for the fractional synthesis rate of fibrinogen (p = 0.008) but not for albumin (p = 0.12). Repeated measurements of albumin de novo synthesis more than 48 hours apart show acceptable agreement using either one or two different isotopic labels. For fibrinogen the larger intra-individual scatter necessitates larger study groups to detect changes in longitudinal studies. Repeated measurements within 48 hours need to be validated further.

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Leakage of albumin in major abdominal surgery

Cited by 45 publications

References 28 publications

Simultaneous assessment of the synthesis rate and transcapillary escape rate of albumin in inflammation and surgery

Simultaneous assessment of the synthesis rate and transcapillary escape rate of albumin in inflammation and surgery

Assessment of Protein Turnover in Health and Disease

Repeated quantitative measurements of De Novo synthesis of albumin and fibrinogen

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