title: Clinical indications for the albumin use: still a controversial issue.
abstract: Human serum albumin (HSA) is the most abundant circulating protein and accounts for about 70% of the plasma colloid osmotic pressure. Beside the well known capacity to act as plasma-expander, HSA is provided of many other properties which are unrelated to the regulation of fluid compartmentalization, including binding and transport of many endogenous and exogenous substances, antioxidant function, immuno-modulation, anti-inflammatory activity, and endothelial stabilization. Treatment (hepatorenal syndrome) or prevention (renal failure after spontaneous bacterial peritonitis and post-paracentesis circulatory dysfunction after large volume paracentesis) of severe clinical complications in patients with cirrhosis and fluid resuscitation in critically ill patients, when crystalloids and non-proteic colloids are not effective or contra-indicated, represents the major evidence-based clinical indications for HSA administration. However, a large proportion of HSA prescription is inappropriate. Despite the existence of solid data against a real benefit, HSA is still given for nutritional interventions or for correcting hypoalbuminemia per se (without hypovolemia). Other clinical uses for HSA administration not supported by definitive scientific evidence are long-term treatment of ascites, nephrotic syndrome, pancreatitis, abdominal surgery, acute distress respiratory syndrome, cerebral ischemia, and enteric diseases. HSA prescription should be not uncritically restricted. Enforcement of clinical practice recommendations has been shown to allow a more liberal use for indications supported by strong scientific data and to avoid the futile administration in settings where there is a lack of clinical evidence of efficacy. As a result, a more appropriate HSA use can be achieved maintaining the health care expenditure under control.
authors.affiliation: U.O. Semeiotica Medica, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy. Electronic address: paolo.caraceni@unibo.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caraceni
authors.forename: Marco
authors.initials: M
authors.lastname: Domenicali
authors.forename: Alessandra
authors.initials: A
authors.lastname: Tovoli
authors.forename: Lucia
authors.initials: L
authors.lastname: Napoli
authors.forename: Carmen Serena
authors.initials: CS
authors.lastname: Ricci
authors.forename: Manuel
authors.initials: M
authors.lastname: Tufoni
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
mesh_terms: D001201:Ascites / Q000188:drug therapy*; D005440:Fluid Therapy / Q000379:methods*; D006530:Hepatorenal Syndrome / Q000188:drug therapy*; D006801:Humans; D034141:Hypoalbuminemia / Q000188:drug therapy* / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D010538:Peritonitis / Q000150:complications; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012709:Serum Albumin / Q000627:therapeutic use*; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy* / Q000628:therapy
chemical_list: D012709:Serum Albumin
keywords: Albumin; Ascites; Fluid resuscitation; HRS; HSA; ICU; Liver cirrhosis; NO; PPCD; SBP; Sepsis; TNF-α; hepatorenal syndrome; human serum albumin; intensive care unit; nitric oxide; post-paracentesis circulatory dysfunction; spontaneous bacterial peritonitis; tumor necrosis factor-α