Albumin Administration Research Articles

The Warming Management Measures May Need to Be Further Enhanced During Scoliosis Correction and Internal Fixation Surgery: A Retrospective Cohort Study.

The incidence of intraoperative hypothermia (IPH) exceeds 70% during spinal surgery, which can lead to many adverse outcomes, including increased intraoperative blood loss/transfusion and delayed recovery. We aimed to evaluate the comprehensive efficiency of a kind of enhanced warming measure on patients undergoing spinal surgery. A retrospective analysis was conducted on the clinical data, surgical procedures, and outcomes of consecutive patients admitted to the department of orthopedics of a hospital from December 2019 to May 2023 and undergoing spinal surgery (scoliosis correction and internal fixation surgery). The impact of the perioperative warming measures on surgical temperature variation and postoperative recovery was analyzed. The surgical patients who received normal active warming measures (quilt, blood transfusion and infusion warming, flushing fluid warming) were the control group (Normal Warming Group [NWG], n = 199), and the enhanced active warming measures (NWG and forced air warming) were the experimental group (Enhanced Warming Group [EWG], n = 201). Incidence of IPH was the primary endpoint of this study. EWG exhibited a significantly reduced incidence of IPH and average frequency of hypothermia per patient compared with NWG (respectively, p < 0.01) and demonstrated notable reductions in intraoperative blood loss, urine output, anesthesia recovery time, and duration of arousal (respectively, p < 0.05, p < 0.01, and p < 0.001). Postoperatively, EWG showed a significantly reduced incidence of shivering (p < 0.001) and had lower costs for postoperative antibiotic use and albumin administration (respectively, p < 0.05 and p < 0.01). So we infer that the occurrence of hypothermia during spinal surgery may seem unavoidable, but EWG can effectively lower the occurrence of IPH and its adverse outcomes, and then somewhat alleviate the postoperative treatment burden. However, given that this study is a retrospective cohort study, it is not yet possible to definitively prove the above conclusions, so we will design relevant prospective clinical studies to prove that the optimization of temperature management may be crucial to ensure optimal overall recovery outcomes.

Albumin for Spontaneous Bacterial Peritonitis: Care Variation, Disparities and Outcomes.

Intravenous albumin reduces mortality in SBP. We sought to characterize albumin use for SBP over time and investigate patient and hospital-level factors associated with use. A retrospective cohort study in the Veterans Health Administration between 2008 and 2021 evaluated trends and patient, practice-, and facility-level factors associated with use among patients with cirrhosis hospitalized for SBP confirmed with ascitic fluid criteria. Among 3,871 Veterans with SBP, 803 (20.7%) did not receive albumin, 1,119 (28.9%) received albumin but not per guidelines and 1,949 (50.3%) received albumin per guidelines; use increased from 66% in 2008 to 88% in 2022. Veterans who identified as Black compared to white were less likely to receive guideline-recommended albumin (OR 0.76, 95%CI 0.59-0.98) in all analyses. Guideline-recommended albumin was more likely to be administered to Veterans with CTP class B (OR 1.39, 95% CI 1.17-1.64) and C (OR 2.21, 95% CI 1.61-3.04) compared to CTP A; and AKI Stage 1 (OR 1.48, 95%CI 1.22 -1.79), Stage 2 (OR 2.17, 95%CI 1.62-2.91), and Stage 3 (OR 1.68, 95%CI 1.18 - 2.40) compared to no AKI. GI/Hepatology consultation (OR 1.60, 95% CI 1.29--1.99), nephrology consultation (OR 1.60, 95%CI 1.23-2.07) and having both GI/hep and nephrology consultations (OR 2.17, 95%CI 1.60-2.96) were associated with higher albumin administration. In exploratory analyses accounting for interactions between model for end stage liver disease sodium (MELD-Na) and albumin, guideline-recommended albumin was associated with lower in-hospital mortality (HR 0.90, 95% CI 0.85 - 0.96). Future studies should investigate optimizing albumin use for SBP to reduce variability and mitigate healthcare disparities.

Validation of Albumin Prescription in Vali Asr and Ayatollah Musavi Zanjan Hospitals

Background: Human serum albumin (HSA) is a versatile protein exclusively produced by hepatocyte cells in the liver, constantly released into the bloodstream. Substantial quantities of HSA are employed to ameliorate a variety of clinical conditions. The purpose of this study was to assess the accuracy of albumin serum administration as recorded in the patient files of Valiasr and Ayatollah Mousavi Hospitals in Zanjan, Iran Methods: his study aimed to assess the accuracy of albumin prescriptions in adult departments of Ayatollah Mousavi and Valiasr hospitals from March 2013 to March 2019. Data on albumin consumption and patient information were collected by reviewing the medical records of patients, resulting in a selection of 316 cases. The study developed a reference framework for assessing albumin administration accuracy. A scoring mechanism was used to categorize prescriptions into appropriate, inappropriate, questionable, and ambiguous classes. Statistical analysis was conducted using SPSS software. Results: The findings indicated that the average patient age was 62.2 years. Among 316 patients, 60.4% were male. The mean serum albumin level was measured at 3.14 g/dL. The collective volume of albumin administered to patients across both hospitals was 5016 units, averaging 15.77 units per patient, and this was utilized over a total of 2253 days. Among the studied patients, 197 passed away during treatment, 110 were discharged, and nine were transferred to other wards. Based on the established reference, it was observed that 5.5% of prescriptions were accurate, 51.9% were inaccurate, 26.4% were debatable, and 0.6% were undetermined. The total cost of prescribing this quantity of albumin in both hospitals amounted to 9,274,584,000 Rials, distributed as 8,347,125,600 Rials and 927,458,400 Rials in their respective proportions. Conclusion: Ultimately, the study highlighted that physician-prescribed albumin, guided by provided instructions, contained numerous errors necessitating vigilant and ongoing oversight. After a comprehensive review of all the data presented, it is apparent that there is no conclusive evidence supporting the existence of a formalized strategy for a consistent reduction in albumin consumption within the hospitals.

Impact of albumin infusion on prognosis in ICU patients with cirrhosis and AKI: insights from the MIMIC-IV database.

Acute kidney injury (AKI) is common in cirrhotic patients, especially in the intensive care unit (ICU), and is often associated with poor prognosis. Albumin is often used for plasma volume expansion, but its efficacy in cirrhotic patients with AKI [excluding hepatorenal syndrome (HRS)] is debated. This study aimed to assess the impact of albumin therapy on prognosis in ICU patients with cirrhosis and non-HRS AKI. A retrospective analysis was conducted using the MIMIC-IV 2.2 database. The primary endpoint was 28-day mortality. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics between the albumin and non-albumin groups. A total of 1,623 patients were included, with 586 receiving albumin. After IPTW, the sample sizes were 1,713 in the non-albumin group and 1,490 in the albumin group. Albumin administration was associated with higher rates of AKI recovery at 48h but did not improve 28-day mortality in the overall cohort. Further analysis revealed that using 5% albumin concentration was associated with improved 28-day mortality (HR 0.68; 95% CI 0.49-0.95; p = 0.025), whereas 25% albumin did not show benefit. In patients with high bilirubin levels, albumin treatment significantly reduced 28-day mortality. However, albumin therapy may increase 28-day mortality in certain subgroups, including patients with chronic kidney disease and baseline albumin levels >3.3g/dL. Although albumin therapy improved 28-day mortality in some cases, it may also increase mortality in certain subgroups. The use of albumin in critically ill patients with cirrhosis and AKI should be approached with greater consideration of its risks and benefits.

Efficacy of albumin use in decompensated cirrhosis and real‐world adoption in Australia

AbstractThe current treatment approach to patients with liver cirrhosis relies on the individual management of complications. Consequently, there is an unmet need for an overall therapeutic strategy for primary and secondary prevention of complications. The clinical potential of long‐term albumin infusions supported by recent clinical trials has expanded its indications and holds promise to transform the management and secondary prevention of cirrhosis‐related complications. This renewed interest in albumin comes with inherent controversies, compounding challenges and pressing need for rigorous evaluation of its clinical potential to capitalize on its therapeutic breakthroughs. Australia is among a few countries worldwide to adopt outpatient human albumin infusion. Here, we summarize currently available evidence of the potential benefits of human albumin for the management of multiple liver cirrhosis‐related complications and discuss key challenges for wide application of long‐term albumin administration strategy in Australian clinical practice. Australian Gastroenterological week (AGW), organised by the Gastroenterological Society of Australia (GESA), was held between 9‐11 September 2022. A panel of hepatologists, advanced liver nurses and one haematologist, were invited to a roundtable meeting to discuss the use of long‐term albumin infusions for liver cirrhosis. management in Australia. In this review, we summarise the proceedings of this meeting in context of the current literature.

Effect of fluid resuscitation with albumin on mortality in patients with severe burns: A nationwide inpatient data analysis

The present study aimed to evaluate the effect of albumin administration on mortality in patients with severe burns. We retrospectively analyzed data from the Diagnosis Procedure Combination Database, a nationwide inpatient database in Japan. We identified patients in the database aged ≥ 15 years who were admitted with severe burns (burn index ≥15) from April 2014 to March 2021. We included patients who received albumin within 2 days of admission in the albumin group and those who did not in the control group. The outcome was the 28-day mortality. Eligible patients (n = 2492) were categorized into an albumin group (n = 1128) or a control group (n = 1364). One-to-one propensity score matching generated 530 pairs of patients with and without albumin administration. The 28-day mortality did not differ significantly between the two groups (albumin vs. control, 21.7 % vs. 22.8 %; risk difference, −1.1 %; 95 % confidence interval, −6.1 % to +3.9 %). These results suggest that albumin administration within 2 days of admission in patients with severe burns may not be associated with mortality during the acute phase.

Comparison of 4% Albumin and Ringer's Acetate on Hemodynamics in On-pump Cardiac Surgery: An Exploratory Analysis of a Randomized Clinical Trial

Compare hemodynamics between 4% albumin and Ringer's acetate. Exploratory analysis of the double-blind randomized ALBumin In Cardiac Surgery trial. Single-center study in Helsinki University Hospital. We included 1,386 on-pump cardiac surgical patients. We used 4% albumin or Ringer's acetate administration for cardiopulmonary bypass priming, volume replacement intraoperatively and 24 hours postoperatively. Hypotension (time-weighted average mean arterial pressure of <65 mmHg) and hyperlactatemia (time-weighted average blood lactate of >2 mmol/L) incidences were compared between trial groups in the operating room (OR), and early (0-6 hours) and late (6-24 hours) postoperatively. Associations of hypotension and hyperlactatemia with the ALBumin In Cardiac Surgery primary outcome (≥1 major adverse event [MAE]) were studied. In these time intervals, hypotension occurred in 118, 48, and 17 patients, and hyperlactatemia in 313, 131, and 83 patients. Hypotension and hyperlactatemia associated with MAE occurrence. Hypotension did not differ between the groups (albumin vs Ringer's: OR, 8.8% vs 8.5%; early postoperatively, 2.7% vs 4.2%; late postoperatively, 1.2% vs 1.3%; all p > 0.05). In the albumin group, hyperlactatemia was less frequent late postoperatively (2.9% vs 9.1%; p < 0.001), but not earlier (OR, 22.4% vs 23.6%; early postoperatively, 7.9% vs 11.0%; both p > 0.025 after Bonferroni-Holm correction). In on-pump cardiac surgery, hypotension and hyperlactatemia are associated with the occurrence of ≥1 MAE. Compared with Ringer's acetate, albumin did not decrease hypotension and decreased hyperlactatemia only late postoperatively. Albumin's modest hemodynamic effect is concordant with the finding of no difference in MAEs between albumin and Ringer's acetate in the ALBumin In Cardiac Surgery trial.

The effect of human albumin administration on postoperative renal function following major surgery: a systematic review and meta-analysis

Optimal fluid management during major surgery is of considerable concern to anesthesiologists. Although crystalloids are the first choice for fluid management, the administration of large volumes of crystalloids is associated with poor postoperative outcomes. Albumin can be used for fluid management and may protect renal function. However, data regarding the effects of albumin administration on kidney function are conflicting. As such, the present study aimed to investigate the effect of albumin administration on renal function in patients undergoing major surgery and compare its effects with those of crystalloid fluid. The Embase, Medline, Web of Science, Cochrane Library, and KoreaMed databases were searched for relevant studies. The primary endpoint of the meta-analysis was the incidence of postoperative kidney injury, including acute kidney injury and renal replacement therapy. Twelve studies comprising 2311 patients were included; the primary endpoint was analyzed in four studies comprising 1749 patients. Perioperative albumin levels in patients undergoing major surgery did not significantly influence kidney dysfunction (p = 0.98). Postoperative fluid balance was less positive in patients who underwent major surgery and received albumin than in those who received crystalloids. Owing to the limitations of this meta-analysis, it remains unclear whether albumin administration during major surgery is better than crystalloid fluid for improving postoperative renal function.

Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients

BackgroundSevere burns induce volume shifts via capillary leaks, eventually requiring massive fluid resuscitation and promoting tissue edema. Albumin may help to mitigate the edema, thereby improving perfusion. This study shows that sublingual microcirculation measurements can quantify both tissue perfusion and edema. MethodsThis prospective observational study was conducted between November 2018 and December 2019 in the intensive care unit of Maasstad Hospital Burn Center, Rotterdam, The Netherlands. Patients with severe burns affecting >15% of the total body surface area were included. Fluid management was conducted in accordance with the Parkland formula. Albumin (20%) was administered at a rate of 0.5 mL/(kg·h), starting 12 h after the burn incident. Alterations in the sublingual microcirculation, including capillary perfusion and density, were measured at admission (T0) and at 4 h (T4) and 12 h (T12) after admission. Sublingual depth of focus (DOF) of the microcirculation was used to quantify the tissue edema. ResultsNine patients were recruited with a mean total body surface area of 36% ± 23%. By T12, a median of 4085 mL (interquartile range [IQR]: 3714–6756 mL) of crystalloids and 446 mL (IQR: 176–700 mL) of 20% albumin were administered. The DOF increased significantly after crystalloid administration (T4 vs. T0, mean difference [MD]=27.4 µm, 95% confidence interval [CI]: 3.4 to 50.9, P=0.040). Following albumin administration, DOF significantly decreased (T12 vs. T4, MD=-76.4 µm, 95% CI: -116.6 to -36.1, P=0.002). Total vessel density decreased significantly with crystalloid administration (T4 vs. T0, MD=-3.5 mm/mm2, 95% CI: -5.7 to -1.4, P=0.004) but increased after albumin administration (T12 vs. T4, MD=6.2 mm/mm2, 95% CI: 3.2 to 9.3, P=0.001). ConclusionSublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns. Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema.

Long-term albumin improves the outcomes of patients with decompensated cirrhosis and diabetes mellitus: Post hoc analysis of the ANSWER trial.

Type-2 diabetes mellitus is a frequent comorbidity of cirrhosis independently associated with cirrhosis-related complications and mortality. This post hoc analysis of the ANSWER trial database assessed the effects of long-term human albumin (HA) administration on top of the standard medical treatment (SMT) on the clinical outcomes of a subgroup of 85 outpatients with liver cirrhosis, uncomplicated ascites and insulin-treated diabetes mellitus type 2 (ITDM). Compared to patients in the SMT arm, the SMT + HA group showed a better overall survival (86% vs. 57%, p = .016) and lower incidence rates of paracenteses, overt hepatic encephalopathy, bacterial infections, renal dysfunction and electrolyte disorders. Hospital admissions did not differ between the two arms, but the number of days spent in hospital was lower in the SMT + HA group. In conclusion, in a subgroup of ITDM outpatients with decompensated cirrhosis and ascites, long-term HA administration was associated with better survival and a lower incidence of cirrhosis-related complications.

Point-of-care ultrasonography in cirrhosis-related acute kidney injury: How I do it

Discerning the etiology of acute kidney injury (AKI) in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes. The conventional approach of empiric albumin administration for suspected volume depletion may inadvertently lead to fluid overload. In the recent past, point-of-care ultrasonography (POCUS) has emerged as a valuable adjunct to clinical assessment, offering advantages in terms of diagnostic accuracy, rapidity, cost-effectiveness, and patient satisfaction. This review provides insights into the strategic use of POCUS in evaluating cirrhotic patients with AKI. The review distinguishes basic and advanced POCUS, emphasizing a 5-point basic POCUS protocol for efficient assessment. This protocol includes evaluations of the kidneys and urinary bladder for obstructive nephropathy, lung ultrasound for detecting extravascular lung water, inferior vena cava (IVC) ultrasound for estimating right atrial pressure, internal jugular vein ultrasound as an alternative to IVC assessment, and focused cardiac ultrasound for assessing left ventricular (LV) systolic function and identifying potential causes of a plethoric IVC. Advanced POCUS delves into additional Doppler parameters, including stroke volume and cardiac output, LV filling pressures and venous congestion assessment to diagnose or prevent iatrogenic fluid overload. POCUS, when employed judiciously, enhances the diagnostic precision in evaluating AKI in cirrhotic patients, guiding appropriate therapeutic interventions, and minimizing the risk of fluid-related complications.

Efficacy and safety of albumin for the treatment of hepatic encephalopathy: an updated systematic review and meta-analysis of randomized controlled trials

Background: Albumin acts as a scavenger of reactive oxygen species and an inhibitor of inflammatory processes that underlie hepatic encephalopathy (HE). However, the role of albumin in hepatic encephalopathy is not well-established. The authors performed this meta-analysis to evaluate the efficacy and safety of albumin in the management of hepatic encephalopathy. Methods: The authors carried out an extensive search across multiple databases, including MEDLINE (via PubMed), Embase, CENTRAL, and various trial registries, to identify randomized controlled trials (RCTs) evaluating the impact of albumin administration in HE. The authors used a random-effects model for analyses and presented dichotomous outcomes and continuous outcomes as relative risk and mean difference, along with corresponding 95% CIs, respectively. Heterogeneity was assessed using both the I2 index and χ2 test. Results: Our meta-analysis included 4 RCTs involving 306 patients. Our primary outcomes, mortality, and persistence of HE were reported by all four studies. Albumin was found to significantly decrease mortality in patients with HE [risk ratio (RR) 0.52, 95% CI 0.32–0.83; I2 =0%]. Persistence of HE was found to be comparable between the two groups (RR 0.83, 95% CI 0.68–1.00; I2 =24%). There was no significant difference between the albumin and control groups regarding length of hospital stay (MD −1.55, 95% CI −3.5 to 0.14; I2 =41%), adverse events (RR 1.00, 95% CI 0.87–1.16; I2 =0%), and severe adverse events (RR 0.89, 95% CI 0.59–1.35). Conclusion: Albumin administration in patients with hepatic encephalopathy decreases mortality but does not significantly impact the persistence of HE. Further high-quality, large-scale randomized controlled trials are needed to provide conclusive evidence.

EFFECTS OF ALBUMIN ADMINISTRATION ON CYTOCHROME C-1 (CYC1) IN ISCHEMIA-REPERFUSION DAMAGED RAT OVARY

This study aimed to examine the effects of albumin administration on ischemia-reperfusion in the rat ovary by using biochemical, histological, and immunohistochemical methods. Thirty-two Wistar albino rats were used in the study, and they were divided into 4 groups: control, albumin, placebo, and ischemia-reperfusion. Healthy ovaries were taken from the first group. In the other three groups, 2-hour ischemia and 2-hour reperfusion were applied to the bilateral ovaries. In the albumin group, intraperitoneal albumin (2.5 g/kg, 20% human albumin) was administered 30 minutes before reperfusion, and in the placebo group, the same volume of intraperitoneal saline was administered instead of albumin 30 minutes before reperfusion. Ovarian damage scores, cytochrome C-1 immunoreactivity, total oxidant status, total antioxidant status, and oxidative stress index levels were evaluated. In the statistical analysis performed between the groups, it was seen that the results of the control group were significantly lower than the ischemia-reperfusion group in terms of total oxidant status values (p=0.001), and the results of the ischemia-reperfusion group were significantly higher than the control and albumin groups in terms of oxidative stress index values (p

Albumin: a comprehensive review and practical guideline for clinical use.

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. 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. 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. 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.

Reduce intraoperative albumin utilisation in cardiac surgical patients: a quality improvement initiative

BackgroundAlbumin continues to be used routinely by cardiac anaesthesiologists perioperatively despite lack of evidence for improved outcomes. The Multicenter Perioperative Outcomes Group (MPOG) data ranked our institution as one of...

Hepatorenal Syndrome Type 1: Diagnosis and Treatment.

Hepatorenal syndrome (HRS)is a feared complication in patients with advanced cirrhosis and is associated with significant morbidity and mortality. While recognized as a distinct physiologic condition for well over one hundred years, a lack of objective diagnostic tests has made the diagnosis one of exclusion. Since 1979, multiple sets of diagnostic criteria have been proposed. Though varying in detail, the principal intent of these criteria is to identify patients with severe, functional acute kidney injury that is unresponsive to volume resuscitation and exclude those with structural injury. However, accurate differential diagnosis remains challenging. Recently, multiple urinary biomarkers of kidney injury, including neutrophil gelatinase-associated lipocalin, have been studied as a means of objectively phenotyping etiologies of acute kidney injury in patients with cirrhosis. Along with markers reflecting tubular functional integrity, includingthe fractional excretion of sodium, injury markers will likely be incorporated into future diagnostic criteria. Making an accurate diagnosis is critical, as therapeutic options exist for HRS but must be given in a timely manner and only to those patients likely to benefit. Terlipressin, an analog of vasopressin, is the first line of therapy for HRS in much of the world and has recently been approved for use in the United States. Significant questions remain regarding the optimal dosing strategy, metrics for titration, and the potential role of point-of-care ultrasound to help guide concurrent albumin administration.

MONITORING OF MEDICINE THERAPY IN DM (Diabetes Mellitus) PATIENTS, MELENA, ANEMIA, HIPOALBUMIN AND SEPSIS IN HOSPITAL “ X ”

Diabetes Mellitus (DM) is a group of chronic metabolic diseases with hyperglycemia characteristics, this disease can attack several organs of the body causing various complaints. Diabetes Mellitus (DM) is a disease characterized by blood sugar levels. Physical activity is any body movement produced by skeletal muscles that requires energy. Lack of physical activity is an independent risk factor for chronic disease. This study aims to determine the effect of physical activity on blood sugar levels in patients with diabetes mellitus. Sepsis is the invasion of pathogenic microorganisms or their toxins into the blood or other tissues, resulting in an exaggerated systemic response to infection, which causes a collection of clinical symptoms and ends in a life-threatening state of organ dysfunction. Anemia is indeed not a direct complication caused by Type 2 DM, but in patients with diabetes, diabetes can damage blood vessels in the body and can cause kidney problems in the long term if not controlled. Impaired kidney function can cause anemia. Melena is a condition when the stool becomes dark or black in color, which is caused by bleeding in the upper gastrointestinal tract. Hypoalbuminemia in critical illness is an important marker of mortality. The pathophysiology of hypoalbuminemia in critical illness including decrease of production, inflammation marker, vascular leakage, and malnutrition. Administration of intravenous human albumin is needed to be considered for treatment of hypoalbuminemia in critical illness.This report was conducted to find out drug related problems (DRP's) in the treatment management of DM (Diabetes Melius) Patients, Melena Anemia, Hipoalbumin and Sepsis at “ X “ Hospital. The patient on behalf of Mrs.R.M was treated in the inpatient room. Drug Therapy Monitoring to ensure rational use of drugs, so that unwanted events do not occur.

The Effect of Albumin Administration in Critically Ill Patients: A Retrospective Single-Center Analysis.

The aim of this study was to analyze the development of albumin administration in patients admitted to the adult ICU. In addition, we assessed the impact of albumin administration on serum hemoglobin concentration. We conducted a retrospective single-center study including all patients who were admitted to the ICU from January 2013 to December 2021 and stayed at least 24 hours. The study was conducted in an academic hospital (University Hospital Basel, Switzerland). A total of 20,927 admissions were included, of which 3748 received albumin at least once during their ICU stay. To analyze volume expansion, 2006 admissions met the inclusion criteria, namely at least two hemoglobin measurements within 12 hours, one albumin delivery, and experienced no bleeding, dialysis, or transfusions during this period. None. We examined the hemoglobin levels before and after albumin administration and compared them with a matched control group to assess the amount and duration of volume expansion. From 2013 to 2021 the proportion of critically ill patients treated with albumin rose from 5.0% to 32.5%. An overproportioned increase in albumin use could be seen in surgical patients (4.7-47.2%) and in those receiving RBC transfusion (13.7-72.6%). In those patients receiving albumin, a significant drop in hemoglobin of around 5 g/L on average could be observed following treatment with albumin. Hemodilution was observable for at least 12 hours after albumin administration and may have caused a decrease in hemoglobin concentration of greater than 8 g/L when isooncotic albumin solution (5%, 25 g in 500 mL) was administered. This makes albumin, especially in its isooncotic form, an ideal colloid to achieve long-lasting volume expansion. However, RBC transfusions may increase under albumin therapy, as transfusion thresholds may be undershot after albumin administration.

Personalised human albumin in patients with cirrhosis and ascites: design and rationale for the ALB-TRIAL - a randomised clinical biomarker validation trial

IntroductionHuman albumin is used in the treatment of complications of cirrhosis. However, the use of long-term human albumin administration is costly and resource demanding for both patients and healthcare systems....

Long-term albumin administration improves survival in outpatients with decompensated cirrhosis and diabetes: post-hoc analysis of the ANSWER Trial

Long-term albumin administration improves survival in outpatients with decompensated cirrhosis and diabetes: post-hoc analysis of the ANSWER Trial