1
|
Abedi F, Zarei B, Elyasi S. Albumin: a comprehensive review and practical guideline for clinical use. Eur J Clin Pharmacol 2024; 80:1151-1169. [PMID: 38607390 DOI: 10.1007/s00228-024-03664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration. METHODS Data collection was carried out until November 2023 by search of electronic databases including PubMed, Google Scholar, Scopus, and Web of Science. GRADE system has been used to determine the quality of evidence and strength of recommendations for each albumin indication. RESULTS A total of 165 relevant studies were included in this review. Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin. Moreover, albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use. Also, in modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation. CONCLUSION Albumin administration is most indicated in management of cirrhosis complications. Fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin. Implementation of evidence-based guidelines in hospitals can be an effective measure to reduce inappropriate uses of albumin.
Collapse
Affiliation(s)
- Farshad Abedi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran
| | - Batool Zarei
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
| |
Collapse
|
2
|
Chen WH, Ye HF, Wu YX, Dai WT, Ling XW, Zhao S, Lin C. Association of creatinine-albumin ratio with 28-day mortality in major burned patients: A retrospective cohort study. Burns 2023; 49:1614-1620. [PMID: 37211475 DOI: 10.1016/j.burns.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/08/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Serum creatinine (Cr) and Albumin (Alb) have emerged as prognostic factors for mortality in many diseases including burned patients. However, few studies report the relationship between Cr/Alb ratio and major burned patients. The purpose of this study is to make evaluation of efficacy of Cr/Alb ratio in predicting 28-day mortality in major burned patients. METHOD Based on a local largest tertiary hospital in South of China, we retrospectively analyzed data of 174 patients with total burn area surface (TBSA) ≥ 30% from January 2010 to December 2022. Receiver operating characteristic curve (ROC), logistic analysis, and Kaplan-Meier analysis were performed to evaluate the association between Cr/Alb ratio and 28-day mortality. Integrated discrimination improvement (IDI), and net reclassification improvement (NRI) were used to estimate the improvements in new model performance. RESULTS 28-day mortality rate was 13.2% (23/174) in burned patients. Cr/Alb on admission at level of 3.340μmol/g showed the best discrimination between survivors and non-survivors after admission at 28 days. The result of multivariate logistic analysis suggested that age (OR, 1.058 [95%CI 1.016-1.102]; p = 0.006), higher FTSA (OR, 1.036 [95%CI 1.010-1.062]; p = 0.006), and higher level of Cr/Alb ratio (OR, 6.923 [95CI% 1.743-27.498]; p = 0.006) were independently associated with 28 day-mortality. A regression model was constructed by logit(p) = 0.057 *Age + 0.035 *FTBA + 1.935 * Cr/Alb - 6.822. The model showed a better discrimination and risk reclassification compared with ABSI and rBaux score. CONCLUSIONS High Cr/Alb ratio at admission is a herald of poor outcome. The model generated from multivariate analysis could serve as an alternative prediction tool among major burned patients.
Collapse
Affiliation(s)
- Wei-Hao Chen
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Yu-Xuan Wu
- Wenzhou Medical University, Wenzhou, China
| | - Wen-Tong Dai
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Wei Ling
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Sheng Zhao
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cai Lin
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
3
|
Akkoç MF, Bülbüloğlu S. Investigation of red cell distribution width as a prognostic criterion in severe burns. Int Wound J 2021; 19:1428-1437. [PMID: 34904354 PMCID: PMC9493245 DOI: 10.1111/iwj.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/16/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
This study was conducted to examine red cell distribution width (RDW) as a prognostic criterion in severe burns. The study is a descriptive correlational study and was carried out retrospectively. Patients with high RDW and low albumin values among severe burn injuries in the burn unit of a university hospital constituted half of the sample. Severe burns with RDW within normal range and a prognostic criterion for which albumin level normal and closest to normal accounted for the other half. RDW and albumin values were compared with the clinical results of patients with severe burns. IBM SPSS (Statistical Package for the Social Sciences) Statistics 25 was used for data analysis. Of the burn patients, 38.33% were between the age of 65–80, 51.67% were men, and 92.5% had third‐degree burns. The mean albumin level of the patients was 2.39 ± 0.34 g/dL, and the mean RDW level was 18.47 ± 6.15%. The length of the stay in the intensive care unit was 13.45 ± 7.83 days, and the duration of central venous catheter use was 23.41 ± 8.25 days. High RDW and low albumin values were found to be associated with death, length of stay in the intensive care unit, and more blood transfusion. High RDW and hypoalbuminemia significantly affect the clinical results of severe burns. Both parameters are effective in determining the clinical course of burn patients, the length of hospital stay, presence of catheters and medication treatment protocol.
Collapse
Affiliation(s)
- Mehmet Fatih Akkoç
- Division of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Semra Bülbüloğlu
- Division of Surgical Nursing, Nursing Department, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| |
Collapse
|
4
|
Noh E, Moon JM, Chun BJ, Cho YS, Ryu S, Kim D. The clinical role of serum albumin in Organophospate poisoning. Basic Clin Pharmacol Toxicol 2020; 128:605-614. [DOI: 10.1111/bcpt.13546] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Eul Noh
- Emergency Department Chonnam National University Hospital Gwangju South Korea
| | - Jeong Mi Moon
- Emergency Department Chonnam National University Hwasun Hospital Hwasun‐gun South Korea
- Emergency Department Chonnam National University Medical School Gwangju South Korea
| | - Byeong Jo Chun
- Emergency Department Chonnam National University Hospital Gwangju South Korea
- Emergency Department Chonnam National University Medical School Gwangju South Korea
| | - Yong Soo Cho
- Emergency Department Chonnam National University Hospital Gwangju South Korea
| | - SeokJin Ryu
- Emergency Department Chonnam National University Hospital Gwangju South Korea
| | - Dongki Kim
- Emergency Department Chonnam National University Hospital Gwangju South Korea
| |
Collapse
|
5
|
Chen YF, Ma H, Perng CK, Liao WC, Shih YC, Lin CH, Chen MC, Hsiao FY, Wang TH. Reply to "Predictors in major burn patients". J Chin Med Assoc 2020; 83:585. [PMID: 32282449 DOI: 10.1097/jcma.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yi-Fan Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wen-Chieh Liao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yu-Chung Shih
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Hsun Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Mei-Chun Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Fu-Yin Hsiao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tian-Hsiang Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| |
Collapse
|
6
|
Affiliation(s)
- Na-Rong Lee
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC
| |
Collapse
|