Moderator Effect of Hypoalbuminemia in Volume Resuscitation and Plasma Expansion with Intravenous Albumin Solution

Abstract

Intravenous administration of crystalloid or colloid solutions is the most common intervention for correcting hypovolemia in intensive care unit (ICU) patients. In critical illness, especially sepsis and severe trauma, vascular wall permeability increases, and trans-endothelial escape of serum albumin, the major oncotic plasma constituent, contributes to the development of hypoalbuminemia and edema formation. The volume effects of intravenous human albumin solution exceed those of crystalloid solutions. If hypoalbuminemia is an effect moderator, the crystalloid-to-albumin ratio of fluid resuscitation volumes is not well characterized. Randomized controlled trials have confirmed that intravenous administration of human albumin solutions for volume resuscitation results in a lower net fluid balance compared with crystalloids, and smaller infusion volumes may be sufficient for hemodynamic stabilization when human albumin solutions are used. This narrative review summarizes the current evidence and conclusions drawn regarding the role of hypoalbuminemia in volume resuscitation. In the ‘Saline versus Albumin Fluid Evaluation’ study using 4% human albumin solution or saline, the saline-to-albumin ratio of study fluids was significantly higher in patients with baseline serum albumin concentrations of 25 g/L or less as compared to patients with baseline serum albumin concentrations of more than 25 g/L. In patients receiving renal replacement therapy, intravenous administration of 20–25% human albumin solution reduces intradialytic hypotension and improves fluid removal better than saline if serum albumin levels are similarly reduced. These data suggest that hypoalbuminemia acts as an effect moderator in volume resuscitation and plasma expansion with albumin solution. The volume effectiveness of intravenous human albumin solution in resuscitation appears to be greater when the serum albumin levels are low. In clinical situations, serum albumin concentrations per se may inform when and how to include intravenous albumin in fluid resuscitation if large amounts of crystalloids are needed, which requires further studies.

siRNA-mediated reduction of a circulating protein in swine using lipid nanoparticles

“… 92 Albumin levels in the siPLG group were reduced at 5 h compared to the control groups, which could be attributed to the mild and transient liver toxicity in these animals, as the liver is the site of albumin synthesis. 93 Inflammation and surgery are also known to decrease albumin levels, 94 and these may have also contributed, although no major signs of inflammation or distress were observed during monitoring. The transient increase in AST levels in swine after administering siPLG is similarly observed in other animal models 95 , 96 and human studies 97 that tested the in vivo delivery of siRNA.…”

Clinical value of the red blood cell distribution width to albumin ratio in the assessment of prognosis in critically ill patients with sepsis: a retrospective analysis

“…The increased vascular permeability in sepsis may increase albumin loss, accelerate the onset of hypoalbuminemia and compound the negative effects of hypoproteinemia in sepsis. Ultimately, a vicious cycle exists between the adverse outcomes of hypoproteinemia and sepsis ( 41 ).…”

Human Albumin Infusion in Critically Ill and Perioperative Patients: Narrative Rapid Review of Meta-Analyses from the Last Five Years

“…It was found that the ratio of administered HA to saline volume required to achieve hemodynamic targets in the first four days was approximately 1 to 1.4 [ 35 ]. The stronger volume effect of HA was even more pronounced in patients with hypoalbuminemia [ 29 ]. In addition, in the ‘Volume Replacement With Albumin in Severe Sepsis’ (ALBIOS) study, which compared the administration of 20% HA, dosed by albumin serum levels, in sepsis patients with 0.9% NaCl, it was confirmed that during the first seven days, patients in the HA group, as compared with those in the crystalloid group, had a higher MAP and lower net fluid balance [ 36 ].…”

“…Hypoalbuminemia, Burns, and Kidney Replacement Therapy Hypoalbuminemia is frequently observed in hospitalized patients and is associated with several diseases [3]. In hypoalbuminemia, supplementation with HA affects surrogate outcome parameters, such as volume effects of resuscitation fluids or diuretic responses to furosemide [28,29]. In burn patients, HA may be administered acutely as a volume expander during burn shock resuscitation and chronically following resuscitation to correct hypoalbuminemia [30].…”