The role of albumin in critical illness

Nicholson, John; Wolmarans, Morné; Park, G.R.

doi:10.1093/bja/85.4.599

Cited by 735 publications

(634 citation statements)

References 88 publications

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“…19 In healthy individuals, 30%-40% of serum albumin is maintained within the vascular compartment; it leaks from plasma at a rate of 5% per hour and is returned at an equivalent rate. 20 Albumin can be reduced as a consequence of an elevated metabolic albumin turnover, accelerated aging of the molecules through oxidative stress, or increased leakage due to immunemediated vasculopathy. 20,21 In line with these characteristics, 71% of our patients had decreased serum albumin levels.…”

Section: Discussionmentioning

confidence: 99%

Type of Edema in Posterior Reversible Encephalopathy Syndrome Depends on Serum Albumin Levels: An MR Imaging Study in 28 Patients

Pirker¹,

Kramer²,

Voller³

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY: PRES is a clinicoradiologic entity, combining seizures, blindness, and coma with MR imaging findings of predominantly vasogenic and occasional cytotoxic edema. In this clinical report, we determined the type of edema by using DWI and FLAIR sequences on MR imaging as well as ADC maps in 28 patients with PRES. The neuradiologic findings were correlated with levels of serum albumin, which is a main contributor to colloid osmotic pressure and vascular integrity. The presence of vasogenic edema was significantly associated with decreased serum albumin levels, which may be a particular risk factor for the development of PRES.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; ANOVA ϭ analysis of variance; CI ϭ confidence interval; COP ϭ colloid osmotic pressure; DWI ϭ diffusion-weighted imaging; FLAIR ϭ fluid-attenuated inversion recovery; IL ϭ Interleukin; KS ϭ Kolmogorov-Smirnov; MWU ϭ Mann Whitney U; NO ϭ nitric oxide; PRES ϭ posterior reversible encephalopathy syndrome; ROS ϭ reactive oxygen species P RES is a clinicoradiologic entity with acute onset of seizures, blindness, alterations of consciousness, and headache. MR imaging is of great importance in the diagnosis of this clinically inhomogeneous syndrome, which typically shows bilateral signal-intensity alterations in cortical and subcortical regions of the posterior circulation, indicating vasogenic edema.1 A low proportion of patients show cytotoxic edema or lesions outside the posterior circulation.2 An association between the etiology of PRES and MR imaging findings has been negated in a recent investigation.3 Additionally, it remains unclear why patients develop either vasogenic or cytotoxic edema in PRES. Cytotoxic and vasogenic edema in PRES can be differentiated by using DWI and FLAIR sequences. 4 It has been postulated that PRES is caused by endothelial damage and dysfunctional cerebral autoregulation due to excessive hypertension, leading to hyperperfusion and subsequent vasogenic edema in susceptible vessels. 5,6 Other risk factors are pre-eclampsia, sepsis, cytotoxic and immunosuppressant drugs, and nephrotic syndrome.7 These conditions all involve high oxidative stress and a systemic proinflammatory process, 8 hinting at additional mechanisms involved in PRES pathogenesis, such as vasoactive substances, vasospasm, and microinfarctions. 9 As seen in nephrotic syndrome, most diseases associated with PRES exhibit significantly reduced serum albumin levels.10 Serum albumin accounts for 75% of plasma protein and, therefore, is a main contributor to COP, reducing perfusion pressure, which results in retention of fluid in the vessel. 11Vasogenic edema can be aggravated by a marked decrease in COP. 12 Albumin protects vascular endothelial cells from oxidative stress and damage, 13 acting as an important antioxidant that preserves vascular integrity.This clinical report describes 28 patients with PRES and focuses on the type of edema in correlation with serum albumin. We show that vasogenic edema in PRES occurs significantly more often in patien...

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Section: Discussionmentioning

confidence: 99%

Type of Edema in Posterior Reversible Encephalopathy Syndrome Depends on Serum Albumin Levels: An MR Imaging Study in 28 Patients

Pirker¹,

Kramer²,

Voller³

et al. 2011

AJNR Am J Neuroradiol

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“…Extrapolation of data from patients with CKD is not ideal given that the time course of disease progression is different. Organ crosstalk, particularly involving the liver and the kidney, can influence drug metabolism 135 , which could reflect the impact of AKI on hepatic blood flow, the consequences of metabolic acidosis or changes in protein binding 136 on drug distribution, and the increasingly recognized effects of AKI on cytochrome P450 activity; overall, the impact of AKI on hepatic drug metabolism seems to be clinically relevant. Impairment of cytochrome P450 activity, as well as effects on drug transporters, could also account for some of the pharmacodynamic effects of AKI.…”

Section: Effect Of Aki and Akd On Drug Metabolismmentioning

confidence: 99%

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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“…The normal halflife of circulating albumin is 19 days. This corresponds to daily degradation of about 10 per cent of the total protein synthesized by the liver (Nicholson et al, 2000). Rothschild et al had shown the loss of albumin In severely burned patients, due to increased capillary permeability and overall reduction in protein synthesis in the liver (Akbal et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Changes in blood protein composition under experimental chemical burns of esophageal development in rats

Ishchuk¹,

Raetska²,

Savchuk³

et al. 2015

Biomed Res Ther

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Abstract-Exogenous poisoning with alkalis takes the leading position among causes of acute poisoning. Esophageal burns as a result of accidental swallowing of caustic material are seen frequently in children ages 1 to 8 years. A burn wound is perhaps the most intense stress that a human body can suffer. In the place of chemical trauma localization the processes of synthesis and degradation of proteins increase. As a result the structure and functions of vital organs and immune system suffer. The inflammation process after burn injury is determines the changes in protein expression. In our research we have shown that chemical burn of the esophagus is characterized by decreased level of total proteolytic activity, total protein and development of endogenous intoxication of the body as indicated by elevated MMM level. Obtained results suggest that the development of chemical burns of the esophagus grade 2 is characterized by more substantial changes in the protein composition of blood compared with grade 1. An in-depth study of this disease has a crucial scientific and practical importance for development of pathogenically oriented methods of wound process healing after the chemical esophageal burns depending on the stage and extent of the burn process.

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The role of albumin in critical illness

Cited by 735 publications

References 88 publications

Type of Edema in Posterior Reversible Encephalopathy Syndrome Depends on Serum Albumin Levels: An MR Imaging Study in 28 Patients

Type of Edema in Posterior Reversible Encephalopathy Syndrome Depends on Serum Albumin Levels: An MR Imaging Study in 28 Patients

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

Changes in blood protein composition under experimental chemical burns of esophageal development in rats

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