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Albumin

Most abundant protein in plasma and exerts 75-80% of the normal colloid osmotic pressure needed for fluid homeostasis.

Direct protective effect in prevention of death.

Decreased serum albumin predicts an increased risk of postoperative infection.

In the healthy elderly population, serum albumin and prealbumin levels are 7% to 10% lower than those in healthy younger individuals.

Prealbumin is least affected by fluctuations of hydration status, liver and renal functions compared to other plasma proteins.

Prealbumin levels drop with acute inflammation, as the liver switches to acute phase protein production and decreases prealbumin production.

Relationship between a low serum albumin level and increased risk of death.

Serum albumin level related to in-hospital mortality, length of stay and nosocomial infection.

Considered an objective measurement of nutritional status.

Albumin levels remain normal in short-term and more prolonged fasting.

Albumin a good indicator of preoperative outcome, but affected by too many variables in the acute care setting to make it reliable marker of nutritional status in the postoperative period.

Concentrations of albumin in whole blood 42.1 g/L, in packed red blood cells 19.1 g/L and in fresh frozen plasma 40.9 g/L.

 

The large majority of oncotic pressure in capillaries is generated by the presence of high quantities of albumin, a protein that constitutes approximately 80% of the total oncotic pressure exerted by blood plasma on interstitial fluid.

 

 

The total oncotic pressure of an average capillary is about 28 mmHg with albumin contributing approximately 22 mmHg of this oncotic pressure. 

Indications include: hyopovolemia, shock, burns, hypoalbuminemia, hypoproteinemia, trauma, cardiopulmonary bypass, acute respiratory distress syndrome, hemodialysis, acute nephrosis, hyperbilirubinemia, acute liver failure, ascites, sequestration of protein rich fluids in the peritoneum, pancreatitis, mediastinitis, and cellulitis.

In a large double-blind randomized trial of saline versus albumin fluid in which a 4% albumin solution was compared with normal saline as fluid replacement in critically ill patients: albumin administration was safe (SAFE study).

Malnutrition and inflammation suppress albumin synthesis.

Creatinine ratio greater than 30 mg/g in spot urine sample is abnormal.

60% not filtered by the glomerular apparatus due to its negative surface charge.

Hypoalbuminemic burn patients receiving albumin have a mortality that exceeds that of controls.

In cirrhotic patients with spontaneous bacterial peritonitis albumin administration reduces mortality and renal impairment.

In cancer patients the level of albumin correlates with percentage ideal body weight and extent of weight loss.

Synthesis in cancer patients is the same as in healthy individuals.

In cancer patients there is an inverse relationship between C-reactive protein and albumin levels.

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