The formation and rapid clearance of a truncated albumin species in a critically ill patient.
BACKGROUND
Hypoalbuminemia is known to occur in critically ill patients and is associated with increased mortality. We observed a potentially novel, partial explanation for the hypoalbuminemia noticed in a severely traumatized patient.


METHODS
We report of a severely, multi-system traumatized patient in whom hypoalbuminemia was present (1-2 g/dl). The plasma albumin (HSA) was analyzed by liquid chromatography/positive electrospray ionization mass spectrometry. A high percentage of a truncated albumin that lost its carboxy terminal amino acid leucine (HSA-L) associated with a 10-fold increase in plasma carboxypeptidase A (CPA) activity (R(2)=0.994) were found. We estimated the half life of this truncated albumin species to be <80 h.


CONCLUSIONS
The increased CPA activity encountered following a traumatic event and subsequent rapid clearance of the resulting HSA-L from plasma might be a contributing factor to the hypoalbuminemia observed in the critically ill patients.
Bar-Or
David
D
Swedish Medical Center, Trauma Research Laboratory, 501 E. Hampden Ave., Englewood, CO 80113, USA. dbaror@dmibio.com
Rael
Leonard T
LT
Bar-Or
Raphael
R
Slone
Denetta S
DS
Craun
Michael L
ML
D000063:Accidents, Traffic; D000293:Adolescent; D002853:Chromatography, Liquid; D016638:Critical Illness; D006801:Humans; D008297:Male; D012709:Serum Albumin / Q000096:biosynthesis* / Q000378:metabolism*; D021241:Spectrometry, Mass, Electrospray Ionization
D012709:Serum Albumin