Non-oncotic properties of albumin. A multidisciplinary vision about the implications for critically ill patients

Abstract

Effective resuscitation with human albumin solutions is achieved with less fluid than with crystalloid solutions. However, the role of albumin in today's critical care unit is also linked to its multiple pharmacological effects. Areas covered: The potential clinical benefits of albumin in select populations of critically ill patients like sepsis seem related to immunomodulatory and anti-inflammatory effects, antibiotic transportation and endothelial stabilization. Albumin transports many drugs used in critically ill patients. Such binding to albumin is frequently lessened in critically ill patients with hypoalbuminemia. These changes could result in sub-optimal treatment. Albumin has immunomodulatory capacity by binding several bacterial products. Albumin also influences vascular integrity, contributing to the maintenance of the normal capillary permeability. Moreover, the albumin molecule encompasses several antioxidant properties, thereby significantly reducing re-oxygenation injury, which is especially important in sepsis. In fact, most studies of albumin administration are a combination of a degree of resuscitation with a degree of maintenance or supplementation of albumin. Expert commentary: The potential clinical benefits of the use of albumin in selected critically ill patients such as sepsis seem related to its immunomodulatory and anti-inflammatory effects, antioxidant properties, antibiotic transportation and endothelial stabilization. Additional studies are warranted to further elucidate the underlying physiologic and molecular rationale.

Comparative pathophysiology and management of protein‐losing enteropathy

“…It is interesting to note that, in contrast, disease‐associated deaths from 2 published outcome studies of IBD in dogs were considerably lower at 13% and 18%, suggesting that the PLE underlying disease mechanisms are not merely a more severe continuum of IBD spectrum pathophysiology. Perhaps, this is not unexpected when considering the functions of lymph fluid in immune defense, and the role of albumin in systemic immunomodulatory and anti‐inflammatory activities, antioxidant properties, and endothelial stabilization …”

“…When TE is suspected, HS or purified canine albumin is preferable over plasma transfusion to avoid thrombus extension. The provision of parenteral nutrition via a central venous catheter is another means of increasing plasma oncotic pressure while providing nutritional support, with the unfortunate caveat of higher risks of sepsis, local infection/abscess, and thrombosis …”

CURB-65 plus Hypoalbuminemia: a new score system for prediction of the in-hospital mortality risk in patients with SARS-CoV-2 pneumonia

“…In fact, it has been recently demonstrated that an albumin level <3.5 g/dL was associated with worse outcome and coagulopathy [25][26]. In order to understand the pivotal role of albumin in SARS-CoV-2 infection, we should be aware that serum albumin possesses anti-oxidant and anti-in ammatory properties and behaves as an inverse acute phase reactant during acute systemic in ammation [27][28][29]. Furthermore, stressed and in amed cells increase the uptake of albumin from the circulation, thus highlighting a complex relationship between in ammation/infection and albumin level in the extracellular matrix [30][31].…”

A Predicative Patient Specific Model for Human Albumin Based on Deep Neural Networks

“…Recent evidence and experts' consensus seem to favor the use of hypertonic albumin considering its effect on organ protection and edema correction [4]. 3) How to maintain the plasm albumin level at an optimal range by intravenous administration of albumin in selected time intervals [5]. So far, there have been a few clinical trials reported in the literature, targeting at the questions directly.…”