Abstract
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.
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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.
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.
Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17:432–7.
Franch-Arcas G. The meaning of hypoalbuminemia in clinical practice. Clin Nutr. 2001;20:265–9.
Soeters PB. Rationale for albumin infusions. Curr Opin Clin Nutr Metab Care. 2009;12:258–64.
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.
Vincent JL. Relevance of albumin in modern critical care medicine. Best Pract Res Clin Anaesthesiol. 2009;23:183–91.
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.
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).
The SAFE Study Investigators. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. N Engl J Med. 2007;357:874–84.
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.
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.
Goldwasser P, Feldman J. Association of serum albumin and mortality risk. J Clin Epidemiol. 1997;50:693–703.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Hill AB. The environment and disease. Proc Royal Soc Med. 1965;58:295–300.
Kellum J. Disorders of acid–base balance. Crit Care Med. 2007;35:2630–6.
Halliwell B. Albumin: an important extracellular antioxidant. Biochem Pharmacol. 1988;37:569–71.
Tanemoto M. Effect of serum albumin on serum sodium: necessity to consider the Donnan effect. QJM. 2008;101:827–8.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Chuang VT, Otagiri M. Recombinant human serum albumin. Drugs Today. 2007;43:547–61.
Michelis R, Kristal B, Snitkovsky T, Sela S. Oxidative modification impair albumin quantification. Biochem Biophys Res Commun. 2010;401:137–42.
Foley EF, Boriase BC, Dzik WH, Bistrian BR, Benotti PN. Albumin supplementation in the critically ill. Arch Surg. 1990;125:739–42.
Vincent JL, Dubois M, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? Ann Surg. 2003;237:319–34.
Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomized controlled trials. BMJ. 1998;317:235–40.
Nordstrom CH. Physiological and biochemical principles underlying volume-targeted therapy: the “Lund Concept”. Neurocrit Care. 2005;2:83–95.
Grande PO. The “Lund Concept” for the treatment of severe head trauma-physiological principles and clinical application. Intensive Care Med. 2006;32:1475–84.
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.
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.
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.
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Powner, D.J. In My Opinion: Serum Albumin Should be Maintained During Neurocritical Care. Neurocrit Care 14, 482–488 (2011). https://doi.org/10.1007/s12028-011-9513-z
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DOI: https://doi.org/10.1007/s12028-011-9513-z