title: Albumin Kinetics in Patients Undergoing Major Abdominal Surgery.
abstract: BACKGROUND
  The drop in plasma albumin concentration following surgical trauma is well known, but the temporal pattern of the detailed mechanisms behind are less well described. The aim of this explorative study was to assess changes in albumin synthesis and transcapillary escape rate (TER) following major surgical trauma, at the time of peak elevations in two well-recognized markers of inflammation.
  
  
  METHODS
  This was a clinical trial of radiolabeled human serum albumin for the study of TER and plasma volume. Ten patients were studied immediately preoperatively and on the 2nd postoperative day after major pancreatic surgery. Albumin synthesis rate was measured by the flooding dose technique employing incorporation of isotopically labelled phenylalanine.
  
  
  RESULTS
  Fractional synthesis rate of albumin increased from 11.7 (95% CI: 8.9, 14.5) to 15.0 (11.7, 18.4) %/day (p = 0.027), whereas the corresponding absolute synthesis rate was unchanged, 175 (138, 212) versus 150 (107, 192) mg/kg/day (p = 0.21). TER was unchanged, 4.9 (3.1, 6.8) %/hour versus 5.5 (3.9, 7.2) (p = 0.63). Plasma volume was unchanged but plasma albumin decreased from 33.5 (30.9, 36.2) to 22.1 (19.8, 24.3) g/L. (p<0.001).
  
  
  CONCLUSIONS
  Two days after major abdominal surgery, at the time-point when two biomarkers of generalised inflammation were at their peak and the plasma albumin concentration had decreased by 33%, we were unable to show any difference in the absolute synthesis rate of albumin, TER and plasma volume as compared with values obtained immediately pre-operatively. This suggests that capillary leakage, if elevated postoperatively, had ceased at that time-point. The temporal relations between albumin kinetics, capillary leakage and generalised inflammation need to be further explored.
  
  
  BACKGROUND
  clinicaltrialsregister.eu: EudraCT 2010-08529-21 ClinicalTrials.gov NCT01194492.
authors: Department of Anaesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors: Åke
authors: Å
authors: Norberg
authors: Department of Anaesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors: Olav
authors: O
authors: Rooyackers
authors: Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors: Ralf
authors: R
authors: Segersvärd
authors: Department of Anaesthesia and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
authors: Jan
authors: J
authors: Wernerman
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D011184:Postoperative Period; D012709:Serum Albumin / Q000378:metabolism*; D013514:Surgical Procedures, Operative
chemical_list: D012709:Serum Albumin