serum albumin

Increasing serum albumin protective against metabolic syndrome

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Among healthy adults, increasing serum albumin levels are associated with a decreased risk for metabolic syndrome, independent of higher baseline albumin levels, recent findings suggest.

“The results of the current study support the idea that serum albumin change might be one of the major antioxidative biomarkers for the prediction of incident metabolic syndrome,” Sang-Man Jin, MD, clinical assistant professor at Samsung Medical Center and Sungkyunkwan University School of Medicine in Seoul, South Korea, and colleagues wrote. “Although the mechanism cannot be determined directly based upon the current data, we speculate that the chronic inflammation and oxidative stress involved in the initiation of metabolic syndrome could explain the association between change in serum albumin concentration and the risk of incident metabolic syndrome.”

In a retrospective, longitudinal study of electronic medical records, Jin and colleagues analyzed data from 12,567 adults without metabolic syndrome, diabetes or cardiovascular disease at baseline enrolled in a health screening program at Samsung Medical Center. Patients had at least four follow-up visits between 2006 and 2012. The risk for developing metabolic syndrome was analyzed according to baseline serum albumin level and change in serum albumin concentration during follow-up.

During a mean 5.02 years’ follow-up (63,060 person-years) 2,582 adults (20.55%; 1,746 men) developed metabolic syndrome between 2006 and 2012. Researchers found that, as percent change in serum albumin level increased, the rate of incident metabolic syndrome decreased, as did the proportion of men, BMI, waist circumference, systolic and diastolic blood pressure, fasting insulin and cholesterol levels. In the fully adjusted model, when compared with patients in the first quartile of change in serum albumin level (negative percent change), the HR for metabolic syndrome among patients in the fourth quartile ( 8.51% increase) was 0.262 (95% CI, 0.224-0.305); HR for those in the third quartile (< 8.51% increase) was 0.353 (95% CI, 0.307-0.405); HR for those in the second quartile (0-4.55% increase) was 0.478 (95% CI, 0.421-0.544). Researchers also observed an inverse correlation between percent change in serum albumin and serum level of high-sensitivity C-reactive protein (P < .001). – by Regina Schaffer

Albumin Supplementation in Sepsis Patients.

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Fluid administration is one of the most common items managed every day in hospitalized and intensive care unit (ICU) patients. The optimal fluid for sepsis resuscitation remains unknown, with concerns about both crystalloids and colloids.[1]

Caironi and colleagues sought to examine whether albumin supplementation would benefit patients with severe sepsis and septic shock. This study randomly assigned 1818 of these patients within 24 hours of ICU admission to receive either crystalloids or crystalloids plus albumin supplementation, to maintain a serum albumin level of 3 g/dL.

Early in the course, albumin-treated patients had at least intermittently higher central venous pressure, higher mean arterial pressure, and less positive fluid balance. There was no difference in mortality at 28 days or 90 days, although the subset of patients with septic shock treated with albumin did have a lower mortality at 90 days (43.6% vs 49.9%; P = .03).

A growing body of literature suggests that hydroxyethyl starch solutions may cause renal damage, particularly in patients with sepsis.[2-5] Conversely, albumin has been suggested to confer benefit in sepsis resuscitation.[6,7]

In this study, albumin supplementation to maintain normal circulating serum albumin levels was not shown to be superior overall to crystalloid administration alone. This was true for starting the intervention earlier or later (< 6 hours vs 6-24 hours), and for outcomes measured earlier or later. But the subset of patients with septic shock did have statistically greater survival at 90 days, which raises the question of albumin superiority for this subgroup, and perhaps even as a later effect not related to the early resuscitation.[8]

Unfortunately, for general patient care, this study does not provide a definite answer. And the major question of whether different uses of albumin, such as in the earliest phases of fluid resuscitation and targeted to goals other than maintaining circulating level, still needs to be studied.