Abstract
Hypoalbuminemia is associated with the acquisition and severity of infectious diseases, and intact innate and adaptive immune responses depend on albumin. Albumin oxidation and breakdown affect interactions with bioactive lipid mediators that play important roles in antimicrobial defense and repair. There is bio-mechanistic plausibility for a causal link between hypoalbuminemia and increased risks of primary and secondary infections. Serum albumin levels have prognostic value for complications in viral, bacterial and fungal infections, and for infectious complications of non-infective chronic conditions. Hypoalbuminemia predicts the development of healthcare-associated infections, particularly with Clostridium difficile. In coronavirus disease 2019, hypoalbuminemia correlates with viral load and degree of acute lung injury and organ dysfunction. Non-oncotic properties of albumin affect the pharmacokinetics and pharmacodynamics of antimicrobials. Low serum albumin is associated with inadequate antimicrobial treatment. Infusion of human albumin solution (HAS) supplements endogenous albumin in patients with cirrhosis of the liver and effectively supported antimicrobial therapy in randomized controlled trials (RCTs). Evidence of the beneficial effects of HAS on infections in hypoalbuminemic patients without cirrhosis is largely observational. Prospective RCTs are underway and, if hypotheses are confirmed, could lead to changes in clinical practice for the management of hypoalbuminemic patients with infections or at risk of infectious complications.
Highlights
Albumin is abundant in human blood, and research has identified a wide range of putative roles for the protein in modifying inflammation, maintaining vascular endothelial integrity and acid-base balance, and ligating endogenous and exogenous compounds [1].Albumin can offer protection from inflammatory processes and the associated damage to microcirculation and tissues [2]
Hypoalbuminemia is associated with the acquisition and severity of viral, bacterial, and fungal infections and predicts infectious complications in non-infective disease
randomized controlled trials (RCTs) at low risk of bias showing that supplementation of albumin with human albumin solution (HAS) can affect innate and adaptive immune responses with beneficial outcome
Summary
Albumin is abundant in human blood, and research has identified a wide range of putative roles for the protein in modifying inflammation, maintaining vascular endothelial integrity and acid-base balance, and ligating endogenous and exogenous compounds [1]. The therapeutic use of human albumin solution (HAS) in critically ill or surgical patients and to correct hypoalbuminemia has been studied for decades. Guidelines and consensus recommendations favor use of HAS over either crystalloids alone or synthetic colloids (in particular hydroxyethyl starch) in spontaneous bacterial peritonitis (SBP) and other complications of cirrhosis [8,9]. The mechanisms involved in this effect are not clear and final data from further studies investigating the effects of HAS in preventing infections in patients with advanced liver disease are not yet fully available [12,13]. A non-systematic search of the literature was performed in EMBASE with the terms “(‘hypoalbuminemia’/exp OR hypoalbuminemia) AND (‘infection’/exp OR infection)” to identify studies published since. 2600 search hits were screened across a range of different disease settings, and identified studies were included in this report when deemed relevant
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