Abstract
BackgroundBetter knowledge of albumin kinetics is needed to define the indications for albumin use in clinical practice. This study involved two approaches: the synthesis rate and transcapillary escape rate of albumin were measured simultaneously at different levels of plasma albumin concentration in relation to acute inflammation and surgery; and two different tracers were compared to determine plasma volume and the transcapillary escape rate.MethodsHealthy volunteers (n = 10), patients with acute inflammatory abdominal disease (n = 10), and patients undergoing elective pancreatic resection (n = 10) were studied. The albumin synthesis rate was measured by the incorporation of deuterium-labeled phenylalanine. Plasma volume and the transcapillary escape rate were assessed using 123I-labeled and 125I-labeled albumin.ResultsA 50 % elevated de-novo albumin synthesis rate was seen in patients with acute inflammation and marked hypoalbuminemia, while patients with marginal hypoalbuminemia before the start of surgery had a normal albumin synthesis rate. The transcapillary escape rate was elevated intraoperatively during the reconstructive phase of pancreatic surgery, when plasma albumin was decreased but stable. In acute inflammation with marked hypoalbuminemia, the transcapillary escape rate was no different from normal. 123I-labeled and 125I-labeled albumin were found exchangeable for plasma volume determinations, but could be used only in groups of patients for the transcapillary escape rate.ConclusionsThis observational study illustrates the limited information contained in albumin plasma concentrations to reflect albumin kinetics. On the contrary, single measurements of the synthesis rate and/or transcapillary escape rate of albumin obviously cannot explain the plasma level of albumin or the changes seen in plasma albumin concentration.Trial registration www.clinicaltrials.gov, study number NCT01686776. Registered 13 September 2012.
Highlights
Better knowledge of albumin kinetics is needed to define the indications for albumin use in clinical practice
Data from one subject in groups: healthy volunteers (group A) and from one subject in group C were excluded from the plasma volume (PV) and transcapillary escape rate (TER) results
This study provides new information on the temporal development of albumin kinetics during major abdominal surgery associated with hypoalbuminemia and an increase in capillary leakage
Summary
Better knowledge of albumin kinetics is needed to define the indications for albumin use in clinical practice. This study involved two approaches: the synthesis rate and transcapillary escape rate of albumin were measured simultaneously at different levels of plasma albumin concentration in relation to acute inflammation and surgery; and two different tracers were compared to determine plasma volume and the transcapillary escape rate. Exogenous albumin is used extensively in clinical practice, for hemodynamic stabilization and to treat hypoalbuminemia [1]. Acute catabolism and inflammation are associated with a low plasma albumin concentration, there is simultaneously a high synthesis rate of albumin [6, 7]. Komáromi et al Critical Care (2016) 20:370 This is in contrast to other states of hypoalbuminemia, like malnutrition and liver failure, when there is a low synthesis rate of albumin [8]. The albumin in-vivo synthesis rate is measured quantitatively by the incorporation of isotope-labeled amino acids into albumin. The constant infusion method uses an infusion of a stable isotope-labeled amino acid during 4–12 h and blood sampling during the infusion period, while the flooding technique uses administration of a bolus of isotope-labeled amino acid followed by blood sampling during 90 min [5, 9, 10]
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