Neurocritical Care

, Volume 14, Issue 3, pp 482–488 | Cite as

In My Opinion: Serum Albumin Should be Maintained During Neurocritical Care



Hypoalbuminemia is common among critically ill/injured patients and is strongly associated with increased morbidity and mortality in the patients with and without neurological conditions. Normal serum albumin is important as the primary intravascular antioxidant, in transporting a variety of hormones, medications and electrolytes, in providing colloid osmotic pressure during trans-compartmental fluid movement, in enhancing organ and tissue blood flow, and in supporting acid–base balance. Studies of albumin administration during intravascular resuscitation have not addressed potential longer term benefits to sustaining serum albumin concentrations during critical care. Evidence for such benefit is present although additional prospective studies are needed.


Serum albumin Brain injuries Brain infarction Cerebrovascular accident 


Conflict of interest



  1. 1.
    Minchiotti L, Galliano M, Kragh-Hansen U, Peters T. Mutations and polymorphisms of the gene of the major human blood protein, serum albumin. Hum Mutat. 2008;29:1007–116.PubMedCrossRefGoogle Scholar
  2. 2.
    Dammacco F, Miglietta A, D’Addabbo A, Fratello A, Moschetta R, Bonomo L. Analbuminemia: report of a case and review of the literature. Vox Sang. 1980;39:153–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17:432–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Franch-Arcas G. The meaning of hypoalbuminemia in clinical practice. Clin Nutr. 2001;20:265–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Soeters PB. Rationale for albumin infusions. Curr Opin Clin Nutr Metab Care. 2009;12:258–64.PubMedCrossRefGoogle Scholar
  6. 6.
    Caironi PP, Gattinoni L. The clinical use of albumin: the point of view of a specialist in intensive care. Blood Transfus. 2009;7:259–67.PubMedGoogle Scholar
  7. 7.
    Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009;23:183–91.PubMedCrossRefGoogle Scholar
  8. 8.
    The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004;350:2247–56.CrossRefGoogle Scholar
  9. 9.
    Jacob M, Chappell D, Conzen P, Wilkes MM, Becker BF, Rehm M. Small-volume resuscitation with hyperoncotic albumin: a systematic review of randomized clinical trials. Crit Care. 2008;12:R34. (Epub 2008 Mar4).PubMedCrossRefGoogle Scholar
  10. 10.
    The SAFE Study Investigators. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357:874–84.CrossRefGoogle Scholar
  11. 11.
    The SAFE Study Investigators. Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis. Intensive Care Med. 2011;37:86–96.CrossRefGoogle Scholar
  12. 12.
    Zisman DA, Kawuts M, Lederer DJ, Belperio JA, Lynch JP, Schwarz MI, et al. Serum albumin concentration and waiting list mortality in idiopathic interstitial pneumonia. Chest. 2009;135:929–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50:693–703.PubMedCrossRefGoogle Scholar
  14. 14.
    Iwata M, Kuzuya M, Kitagawa Y, Iguchi A. Prognostic value of serum albumin combined with serum C-reactive protein levels in older hospitalized patients: continuing importance of serum albumin. Aging Clin Exp Res. 2006;18:307–11.PubMedGoogle Scholar
  15. 15.
    Horwich TB, Kalantar-Zadeh K, MacLellan RW, Fonarrow GC. Albumin levels predict survival in patients with systolic heart failure. Am Heart J. 2008;155:883–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Reuben DB, Ferrucci L, Wallace R, Tracy RP, Corti MC, Heimovitz H, et al. The prognostic value of serum albumin in healthy older persons with low and high serum interleukin-6 (IL-6) levels. J Am Geriatr Soc. 2000;48:1404–7.PubMedGoogle Scholar
  17. 17.
    Lohsiriwat V, Lohsiriwat D, Boonnuch W, Chinswangwatanakul V, Akaraviputh T, Lert-Akayamanee N. Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery. World J Gastroenterol. 2008;14:1248–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Menon V, Greene T, Wang X, et al. C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease. Kidney Int. 2005;68:766–72.PubMedCrossRefGoogle Scholar
  19. 19.
    Capelli JP, Kushner H. Correlates affecting survival in chronic hemodialysis patients: the combined impact of albumin and high hemoglobin levels on improving outcomes, local and national results. Hemodial Int. 2008;12:450–62.PubMedCrossRefGoogle Scholar
  20. 20.
    Golub R, Sorrento JJ, Cantu R, Nierman DM, Moideen A, Stein HD. Efficacy of albumin supplementation in the surgical intensive care unit: a prospective, randomized study. Crit Care Med. 1994;22:613–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Hennessey DB, Burke JP, Ni-Dhonochu T, et al. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg. 2010;252:325–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Cho YM, Choi IS, Bian RX, Kim JH, Ham JY, Lee SG. Serum albumin at admission for prediction of functional outcome in ischemic stroke patients. Neurol Sci. 2008;29:445–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Dziedzic T, Pera J, Slowik A, Gryz-Kurek EA, Szczudlik A. Hypoalbuminemia in acute ischemic stroke patients: frequency and correlates. Eur J Clin Nutr. 2007;61:1318–22.PubMedCrossRefGoogle Scholar
  24. 24.
    Bernard F, Al-Tamimi YZ, Chatfield D, Lynch AG, Matta BF, Menon DK. Serum albumin level as a predictor of outcome in traumatic brain injury: potential for treatment. J Trauma. 2008;64:872–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Schirmer-Mikalsen K, Vik A, Gisvold SE, Skandsen T, Hynne H, Klepstad P. Severe head injury: control of physiological variables, organ failure and complications in the intensive care unit. Acta Anaesthesiol Scand. 2007;51:1194–201.PubMedGoogle Scholar
  26. 26.
    Famakin B, Weiss P, Hertzberg V, et al. Hupalbuminemia predicts acute stroke mortality: Paul Coverdell Georgia Stroke Registry. J Stroke Cerebrovasc Dis. 2010;19:17–22.PubMedCrossRefGoogle Scholar
  27. 27.
    Crumley AB, Stuart RC, McKernan M, McMillan DC. Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg. 2010;34:2393–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Hill AB. The environment and disease. Proc Royal Soc Med. 1965;58:295–300.Google Scholar
  29. 29.
    Kellum J. Disorders of acid–base balance. Crit Care Med. 2007;35:2630–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Halliwell B. Albumin: an important extracellular antioxidant. Biochem Pharmacol. 1988;37:569–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Tanemoto M. Effect of serum albumin on serum sodium: necessity to consider the Donnan effect. QJM. 2008;101:827–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Haynes GR, Navickis RJ, Wilkes MM. Albumin administration–what is the evidence of clinical benefit? A systematic review of randomized controlled trials. Eur J Anaesthesiol. 2003;20:771–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Martin GS, Moss M, Wheeler AP, Mealer M, Morris JA, Bernard GR. A randomized, controlled trial of furosemide with or without albumin in hypoproteinemic patients with acute lung injury. Crit Care Med. 2005;33:1681–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Vincent JL, Navickis RJ, Wilkes MM. Morbidity in hospitalized patients receiving human albumin: a meta-analysis of randomized, controlled trials. Crit Care Med. 2004;32:2029–38.PubMedCrossRefGoogle Scholar
  35. 35.
    Quinlan GJ, Mumby S, Martin GS, Bernard GR, Gutteridge JMC, Evans TW. Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury. Crit Care Med. 2004;32:755–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Dubois MJ, Orellana-Jimenez C, Melot C, et al. Albumin administration improves organ function in critically ill hypoalbuminemic patients: a prospective, randomized, controlled, pilot study. Crit Care Med. 2006;34:2536–40.PubMedCrossRefGoogle Scholar
  37. 37.
    Brown RO, Bradley JE, Bekemeyer WB, Luther RW. Effect of albumin supplementation during parenteral nutrition on hospital morbidity. Crit Care Med. 1988;16:1177–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Baker AJ, Park E, Hare GMT, Liu E, Sikich N, Mazer DC. Effects of resuscitation fluid on neurologic physiology after cerebral trauma and hemorrhage. J Trauma. 2008;64:348–57.PubMedCrossRefGoogle Scholar
  39. 39.
    Belayev L, Obenaus A, Zhao W, Saul I, Busto R, Wu C, et al. Experimental intracerebral hematoma in the rat: characterization by sequential magnetic resonance imaging, behavior, and histopathology. Effect of albumin therapy. Brain Res. 2007;1157:146–55.PubMedCrossRefGoogle Scholar
  40. 40.
    Belayev L, Alonso OF, Huh PW, Zhao S, Busto R, Ginsberg MD. Posttreatment with high-dose albumin reduces histopathological damage and improves neurological deficit following fluid percussion brain injury in rats. J Neurotrauma. 1999;16:445–53.PubMedCrossRefGoogle Scholar
  41. 41.
    Ginsberg MD, Zhao W, Belayev L, et al. Diminution of metabolism/blood flow uncoupling following traumatic brain injury in rats in response to high-dose human albumin treatment. J Neurosurg. 2001;94:499–509.PubMedCrossRefGoogle Scholar
  42. 42.
    Belayev L, Liu Y, Zhao W, Busto R, Ginsberg MD. Human albumin therapy of acute ischemic stroke: marked neuroprotective efficacy at moderate doses and with a broad therapeutic window. Stroke. 2001;32:553–60.PubMedGoogle Scholar
  43. 43.
    Jungner M, Bentzer P, Grande PO. Intracranial pressure following resuscitation with albumin or saline in a cat model of meningitis. Crit Care Med. 2011;39:135–40.PubMedCrossRefGoogle Scholar
  44. 44.
    Jungner M, Grande PO, Mattiasson G, Bentzer P. Effects on brain edema of crystalloid and albumin fluid resuscitation after brain trauma and hemorrhage in the rat. Anesthesiology. 2010;112:1194–203.PubMedCrossRefGoogle Scholar
  45. 45.
    Rodling-Wahlstrom M, Olivecrona M, Nystrom F, Koskinen R, Naredi S. Fluid therapy and the use of albumin in the treatment of severe traumatic brain injury. Acta Anaesthesiol Scand. 2009;53:18–25.PubMedCrossRefGoogle Scholar
  46. 46.
    Palesch YY, Hill MD, Ryckborst KJ, Tamariz D, Ginsbert MD. The ALIAS Pilot Trial: a dose-escalation and safety study of albumin therapy for acute ischemic stroke-II: neurologic outcome and efficacy analysis. Stroke. 2006;37:2107–14.PubMedCrossRefGoogle Scholar
  47. 47.
    Ginsberg MD, Palesch YY, Martin RH, et al. The albumin in acute stroke (ALIAS) multicenter clinical trial: safety analysis of part 1 and rationale and design of part 2. Stroke. 2011;42:119–27.PubMedCrossRefGoogle Scholar
  48. 48.
    Tone O, Ito U, Tomita H, Masaoka H, Tominaga B. High colloid oncotic therapy for brain edema with cerebral hemorrhage. Acta Neurochir Suppl (Wien). 1994;60:568–70.Google Scholar
  49. 49.
    Tomita H, Ito U, Tone O, Masaoka H, Tominaga B. High colloid oncotic therapy for contusional brain edema. Acta Neurochir Suppl (Wien). 1994;60:547–9.Google Scholar
  50. 50.
    Barr-Or D, Bar-Or R, Rael LT, Gardner DK, Slone DS, Craun ML. Heterogeneity and oxidation status of commercial human albumin preparations in clinical use. Crit Care Med. 2005;33:1638–41.CrossRefGoogle Scholar
  51. 51.
    Chuang VT, Otagiri M. Recombinant human serum albumin. Drugs Today. 2007;43:547–61.PubMedCrossRefGoogle Scholar
  52. 52.
    Michelis R, Kristal B, Snitkovsky T, Sela S. Oxidative modification impair albumin quantification. Biochem Biophys Res Commun. 2010;401:137–42.PubMedCrossRefGoogle Scholar
  53. 53.
    Foley EF, Boriase BC, Dzik WH, Bistrian BR, Benotti PN. Albumin supplementation in the critically ill. Arch Surg. 1990;125:739–42.PubMedGoogle Scholar
  54. 54.
    Vincent JL, Dubois M, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? Ann Surg. 2003;237:319–34.PubMedGoogle Scholar
  55. 55.
    Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomized controlled trials. BMJ. 1998;317:235–40.Google Scholar
  56. 56.
    Nordstrom CH. Physiological and biochemical principles underlying volume-targeted therapy: the “Lund Concept”. Neurocrit Care. 2005;2:83–95.PubMedCrossRefGoogle Scholar
  57. 57.
    Grande PO. The “Lund Concept” for the treatment of severe head trauma-physiological principles and clinical application. Intensive Care Med. 2006;32:1475–84.PubMedCrossRefGoogle Scholar
  58. 58.
    Eker C, Asgeirsson B, Grande PO, Schalen W, Nordstrom CH. Improved outcome after severe head injury with a new therapy based on principles for brain volume regulation and preserved microcirculation. Crit Care Med. 1998;26:1881–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Naredi S, Olivecrona M, Lingren D, Ostlund AI, Grande PO, Koskinen LOD. An outcome study of severe traumatic head injury using the “Lund therapy” with low-dose prostacyclin. Acta Anaesthesiol Scand. 2001;45:402–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Naredi S, Eden E, Zall S, Stephensen H, Rydenhag B. A standardized neurosurgical/neurointensive therapy directed toward vasogenic edema after severe traumatic brain injury: clinical results. Intensive Care Med. 1998;24:446–51.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Departments of Neurosurgery and Internal MedicineUniversity of Texas Health Sciences Center at Houston Medical SchoolHoustonUSA
  2. 2.Vivian L. Smith Center for Neurological ResearchHoustonUSA

Personalised recommendations