Hypoalbuminemia, or an abnormally ...

Hypoalbuminemia, or an abnormally reasonable level of albumin in the vital fluid is a common condition in patients with serious illness and is correlated with increased morbidity and mortality, and put offed stays in hospitals and intensive care units (ICUs). The relationship between hypoalbuminemia and poor issues has motivated many physicians to administer exogenous albumin to hypoalbuminemic patients; however, there is insufficient evidence to support the efficacy of this practice. Vincent and colleagues performed a systematic review of cohort studies with serum albumin flat as an outcome predictor in acutely ill patients and controll trials that focused upon the correction of hypoalbuminemia.

The meta-analysis plant that the odds of death were increased on 137 percent with each decline of 10 g by L in the serum albumin of the same height Hypoalbuminemia was also a significant predictor of increased morbidity, increased long duration of ICU and hospital stays, and increased use of resources during the period of acute care. Malnutrition and inflammation did not to the full explain the hypoalbuminemic effects.

Nine prospective controll studies evaluated the administration of supplemental albumin to acutely ill patients who had hypoalbuminemia (n = 535) The remainings ratio for complications declined progressively with increases in the attained serum albumin flush Based on these results, the authors gather that attaining a serum albumin horizontal higher than 3 g for dL (30 g per L) probably make lesss morbidity. The protective effects of albumin may be explained by the agency of the maintenance of physiologic homeostasis, including maintenance of normal colloid osmotic influence Other possible positive effects of albumin include its antioxidant properties, capacity to hinder apoptosis, and affinity to bind lipids, medicines and toxic substances.

The authors deduce that albumin-replacement therapy may be clinically appropriate in patients with hypoalbuminemia, although well-designed controll clinical trials are needinessed to confirm benefit.

Vincent JL et al. Hypoalbuminemia in acute illness: is there a rationale for intervention? Ann Surg March 2003; 237:319-34

Editor's note: The administration of albumin to patients with hypoalbuminemia remains controversial. Alderson and associates (1) specifically reviewed the usefulness of albumin administration in critically ill patients with hypovolemia, bakes or hypoalbuminemia. In this meta-analysis of randomized controll trials in which varying compasss and concentrations of albumin were administered and compared with administration of a crystalloid solution, albumin administration was associated with increased mortality. These comes are in contrast to those noted in the article by way of Vincent and colleagues and in a review performed by the agency of Wilkes and Navickis, (2) who examined randomized controll trials of albumin administration in a broader population of patients. In this analysis, there was no association between albumin administration and an increased risk of death compared with patients who received crystalloid therapy, no albumin, or lower dosages of albumin. However, further review of the analysis

by Wilkes and Navickis demonstrates a run toward harm associated with any of the subgroups studied. Further inquiry is needed to identify patient subgroup who may benefit from albumin administration and those who may be harmed.

REFERENCES

(1) Alderson P et al. Human albumin solution for resuscitation and contortion expansion in critically ill patients. Cochrane Database Syst Rev 2002; 1:CD001208

(2) Wilkes MM Navickis RJ Patient survival after human albumin administration. A meta-analysis of randomized, controll trials. Ann Intern M August 7 2001;135:149-64

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group