title: Role of albumin in diseases associated with severe systemic inflammation: Pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis.
abstract: The metabolism of albumin in inflammatory states such as sepsis or major surgery is complex and still not well characterized. Nevertheless, in inflammatory states, albumin synthesis has been observed to increase. By contrast, in decompensated cirrhosis, a disease characterized by systemic inflammation, albumin synthesis by the liver may decrease to 30% to 50% of normal values. Furthermore, in these conditions, there are high capillary leakage and altered albumin kinetics. The discussion regarding the effect of exogenous albumin administration on intravascular volume in inflammatory states should therefore address albumin turnover. To add complexity to our understanding of the effects of albumin, there are many data indicating that the therapeutic action of albumin is mediated not only through the impact on plasma volume expansion but also through a modulatory effect on inflammation and oxidative stress. All these characteristics are relevant to diseases associated with systemic inflammation including sepsis and decompensated cirrhosis.
authors.affiliation: Critical Care Center, CIBER Enfermedades Respiratorias, Sabadell Hospital, Corporació Sanitària Universitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain. Electronic address: aartigas@tauli.cat.
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden. Electronic address: jan.wernerman@karolinska.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Wernerman
authors.affiliation: Liver Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain; Chronic Liver Failure Consortium, Centre Esther Koplowitz, Barcelona, Spain. Electronic address: varroyo@clinic.ub.es.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Anderlecht, Brussels, Belgium. Electronic address: jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Pulmonary and Critical Care Medicine, Rhode Island Hospital, Providence, RI. Electronic address: mitchell_levy@brown.edu.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levy
mesh_terms: D000418:Albumins / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D001810:Blood Volume; D003422:Critical Care; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy*; D018805:Sepsis
chemical_list: D000418:Albumins
keywords: Albumin; Cirrhosis; Hepatorenal syndrome; Inflammation; Sepsis