Hypoalbuminemia: Pathogenesis and Clinical Significance

Peter B. Soeters*, Robert R. Wolfe, Alan Shenkin

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

255 Citations (Web of Science)

Abstract

Hypoalbuminemia is associated with inflammation. Despite being addressed repeatedly in the literature, there is still confusion regarding its pathogenesis and clinical significance. Inflammation increases capillary permeability and escape of serum albumin, leading to expansion of interstitial space and increasing the distribution volume of albumin. The half-life of albumin has been shown to shorten, decreasing total albumin mass. These 2 factors lead to hypoalbuminemia despite increased fractional synthesis rates in plasma. Hypoalbuminemia, therefore, results from and reflects the inflammatory state, which interferes with adequate responses to events like surgery or chemotherapy, and is associated with poor quality of life and reduced longevity. Increasing or decreasing serum albumin levels are adequate indicators, respectively, of improvement or deterioration of the clinical state. In the interstitium, albumin acts as the main extracellular scavenger, antioxidative agent, and as supplier of amino acids for cell and matrix synthesis. Albumin infusion has not been shown to diminish fluid requirements, infection rates, and mortality in the intensive care unit, which may imply that there is no body deficit or that the quality of albumin from the shelf is unsuitable to play scavenging and antioxidative roles. Management of hypoalbuminaemia should be based on correcting the causes of ongoing inflammation rather than infusion of albumin. After the age of 30 years, muscle mass and function slowly decrease, but this loss is accelerated by comorbidity and associated with decreasing serum albumin levels. Nutrition support cannot fully prevent, but slows down, this chain of events, especially when combined with physical exercise.

Original languageEnglish
Pages (from-to)181-193
Number of pages13
JournalJournal of Parenteral and Enteral Nutrition
Volume43
Issue number2
DOIs
Publication statusPublished - Feb 2019

Keywords

  • capillary permeability
  • fractional synthesis rate albumin
  • growth
  • hypoalbuminemia
  • immune response
  • inflammation
  • interstitial space
  • pregnancy
  • puberty
  • serum albumin binding protein
  • serum albumin indicator of inflammatory activity
  • albumin infusion
  • albumin mass
  • serum albumin risk factor
  • albumin scavenger
  • vascular endothelial growth factor
  • NONSTEROIDAL ANTIINFLAMMATORY DRUGS
  • ENDOTHELIAL GROWTH-FACTOR
  • TRANSCAPILLARY ESCAPE RATE
  • LATE PARENTERAL-NUTRITION
  • ALBUMIN SYNTHESIS RATES
  • C-REACTIVE PROTEIN
  • SERUM-ALBUMIN
  • METABOLIC SYNDROME
  • VOLUME EXPANSION
  • RISK-FACTORS

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