Rationale for albumin infusions.
OBJECTIVE
To describe the metabolism and function of albumin, and to scrutinize the evidence that infusion of albumin may be beneficial in disease. To explain why albumin infusion does not improve clinical outcome in most disease states, studied.


RESULTS
Albumin acts as a binding protein and an oncotic agent. However, albumin may also act as an extracellular scavenger, which leads to oxidation of albumin. It is likely that this compromises its function and it is possible that this drives its degradation. In disease, these useful processes are accelerated leading to rapid ageing of the molecule.Albumin infusion does not improve clinical outcome despite increasing oncotic pressure in chronic disease. It is not superior to nonprotein colloids or electrolyte solutions in acute hypovolemia with one or two exceptions (liver failure, possibly cerebral infarction). One potential explanation is that pharmaceutical albumin does not have the oxidative qualities that freshly synthesized albumin has.


CONCLUSIONS
Albumin infusion has not proven to achieve clinical benefit in many acute and chronic disease states with a few exceptions in acute hypovolemia (e.g. postparacentesis). Future studies should reveal whether infusion of freshly synthesized nonoxidized albumin is of greater clinical benefit.
Soeters
Peter B
PB
Department of Surgery, Maastricht University Medical Center, The Netherlands. PB.Soeters@ah.unimaas.nl