RETRACTED: Use of albumin: an update

Abstract

Human albumin (HA) is widely used for volume replacement or correction of hypoalbuminaemia. The value of HA in the clinical setting continues to be controversial, and it is unclear whether in today's climate of cost consciousness, there is still a place for such a highly priced substance. It is therefore appropriate to update our knowledge of the value of HA. With the exception of women in early pregnancy, there appears to be few indications for the use of HA to correct hypovolaemia. Some studies of traumatic brain injury and intensive care patients suggest negative effects on outcome and organ function of (hyperoncotic) HA. Modern synthetic colloids appear to be a cheaper alternative for maintaining colloid oncotic pressure. The value of using HA to correct hypoalbuminaemia has not been clearly justified. Theoretical and pharmacological benefits of HA, such as oxygen radical scavenging or binding of toxic substances, have not as yet been shown to have beneficial clinical consequences. Experimental data from cell lines or animals do not appear to mimic the clinical setting. Convincing data justifying the use of HA either for treating hypovolaemia or for correcting hypoalbuminaemia are still lacking. A restricted use of HA is recommended.

Uso de albumina humana em pacientes graves: controvérsias e recomendações

“…It is the most abundant plasma protein, and it represents 50% of this compartment's total protein. (1) It is synthesized by the liver at a rate of 250 mg/ kg body weight. Its half-life ranges between 18 and 21 days in physiological conditions but can be much shorter in severely ill patients.…”

“…It is likely to regulate vascular properties by maintaining osmotic pressure and microvascular integrity; transport hormones (cortisol and thyroxine), fatty acids, biliary salts, bilirubins, and ions (calcium and magnesium); modulate acidbase balance; and exert antioxidant and anti-apoptotic effects. (1,(10)(11)(12) The chemical structure of serum albumin includes a thiol group that contains a sulfhydryl radical (-SH) with antioxidant properties. (13) It is responsible for 80% of thiol radicals in the circulating blood.…”

“…Albumin administration (dose accumulated) is thought to have renoprotective properties. (1) The SAFE trial has shown a trend toward favorable results after albumin resuscitation relative to saline in septic patients. (27) In this subpopulation, albumin therapy in septic patients was associated with an absolute mortality reduction of almost 5% with a relative risk of 0.87 (95%CI 0.74 -1.02).…”

“…First, it contributes to plasma colloid osmotic pressure recovery by supporting intravascular volume without increasing interstitial edema, a result that is less effectively achieved with crystalloid solutions. (1) Second, serum albumin levels act as a severity indicator for overall clinical status -lower serum albumin levels indicate worse severity. (2) However, despite plausible reasons for the use of albumin, trials have failed to show favorable evidence-based data supporting routine use.…”

“…(7,8) In Brazil, up to 60% of albumin prescriptions may not comply with the Agência Nacional de Vigilância Sanitária (ANVISA, the Brazilian National Health Surveillance Agency,) recommendations. (9) Haroldo Falcão 1,2 , André Miguel Japiassú 1 …”