Serum albumin: touchstone or totem?

Abstract

SummaryA decrease in serum albumin concentrations is an almost inevitable finding in disease states, and is primarily mediated in the acute phase by alterations in vascular permeability and redistribution. This change is not disease specific but marked changes that persist are generally associated with a poorer prognosis. Critical appraisal of long-standing practices and the availability of alternative colloid solutions have led to a reduction in albumin replacement therapy, and a widespread tolerance of lower albumin concentrations in patients. The factors determining serum albumin concentrations, their measurement and the implications of hypoalbuminaemia are reviewed. The clinical value of serum albumin measurement is discussed. Serum albumin is routinely measured and reported in almost every hospital. The measurement is interpreted and acted upon in a wide range of circumstances. In this review we shall address how serum albumin is measured, what the measurement means and the clinical implications and uses of this commonly derived value.In order to understand the issues better, we shall first focus on the physiology involved in the maintenance of serum albumin concentrations, that is the pharmacokinetics, functions and metabolism of endogenous albumin in the normal subject. Secondly, we shall discuss the measurement of serum albumin and the limitations of currently used measurement techniques. We shall then review the mechanisms by which serum albumin concentrations decrease and the 'pathophysiology' of albumin in a number of disease states. Lastly, we shall discuss the interpretation of low values, including their diagnostic and prognostic significance, and the role of albumin supplementation in clinical practice.The traditional term serum albumin will be used throughout, although many people refer to plasma albumin, and the terms are loosely interchangeable. Serum is the term accurately used to describe what is left after a clot has formed in a blood specimen; this fluid is deficient in clotting proteins and, hence, has differing total protein content and colloid osmotic pressures from plasma. The difference in albumin concentrations is negligible, but many laboratories currently perform analyses on nonclotted blood samples, and thus measure plasma albumin.

Loss of functional albumin triggers acceleration of transthyretin amyloid fibril formation in familial amyloidotic polyneuropathy

“…34 It is well documented that serum albumin levels are affected and decreased in various disease conditions, such as hepatic disorders, renal diseases, and burns. 36 The data presented in Table 1 clearly demonstrate significantly decreased serum albumin levels as the disease progressed, which occurs because FAP patients suffer from malnutrition and/or renal disorders as a result of amyloid deposition in the gastrointestinal tract and kidney. [36][37][38] In addition, Biacore analysis showed that albumin had a binding affinity for TTR and exhibited a higher affinity for TTR amyloid (Tables 2 and 3).…”

Pretreatment Serum Albumin Level is an Independent Prognostic Factor in Patients with Stage IIIB Non-Small Cell Lung Cancer: A Study of the Turkish Descriptive Oncological Researches Group

“…Normal serum albumin level ranges between 3.5 and 5.0 g/dL in adults. Hypoalbuminemia is defined as serum albumin <3.5 g/dL (Fearon et al, 1998;Margarson and Soni, 1998;Simons et al, 1999).…”

“…However, serum albumin level may decrease due to inflammation in advanced cancer, cancer cachexia, malnutrition, chemotherapy-related malnutrition, prior surgery-related malnutrition, and terminal stage of the disease. Previous studies showed that hypoalbuminemia was an independent prognostic factor for gastrointestinal and lung cancers (Dewys et al, 1980;Margarson and Soni, 1998;O'Gorman et al, 1998;von Meyenfeldt, 2005). DOI:http://dx.doi.org/10.7314/APJCP.2015.16.14…”

Uso de albumina humana em pacientes graves: controvérsias e recomendações

“…This drop may reach levels of 1-1.15 mg/dL within 3 to 7 days. (11) Intravenous albumin administration is thought to have multiple effects (Figure 1). 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.…”

“…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.…”