Albumin Consumption Research Articles

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.

A clinical study of non-bioartificial liver DPMAES support system in hepatitis B-related acute-on-chronic liver failure

This study aims to observe the clinical efficacy of the dual plasma molecular adsorption exchange system (DPMAES) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), with a focus on its regulatory effect on cytokine storm. A total of 60 HBV-ACLF patients were enrolled in this study. The observation group, comprising 30 patients, received DPMAES treatment, while the control group underwent PE treatment. We compared the efficacy changes between the two groups post-treatment. A total of 55 HBV-ACLF patients who completed the study were analyzed, Patients treated with DPMAES showed significant improvements in clinical outcomes. After DPMAES treatment, HBV-ACLF patients exhibited notably 90 day survival rate increased by 18% compared to those in the PE group. Moreover, total bilirubin levels decreased markedly, albumin and platelet levels increased compared to the PE group. After DPMAES treatment, the patient showed a significant decrease in inflammatory cytokine IL-6 (t = 5.046, P < 0.001) and a significant decrease in procalcitonin (t = 4.66, P < 0.001). DPMAES was more effective than PE in rapidly reducing TBiL, improving coagulation function and mitigating cytokine storm. It maintained platelet stability more effectively while minimizing albumin consumption to a greater extent, significantly improved 90-day survival.Trial registration: Chinese Clinical Trial Registry, ChiCTR2300076117.

Reducing Human Album Solution Use in the Pediatric Intensive Care Unit.

We plotted the mean 5% albumin volume used per PICU admission monthly on statistical process control charts through 3 study periods: baseline period before intervention (July 2019-June 2020), phase 1 (August 2020-April 2021), and phase 2 (May 2021-April 2022). With intervention 1, education, feedback, and an alert sign on 5% albumin stocks began in July 2020. This intervention continued until May 2021, when we executed intervention 2, removing 5% albumin from the PICU inventory. We also examined the lengths of invasive mechanical ventilation and PICU stay as balancing measures across the 3 periods. Mean 5% albumin consumption per PICU admission decreased significantly from 48.1 to 22.4 mL after intervention 1 and 8.3 mL after intervention 2, with the intervention effects persisting for 12 months. Costs associated with 5% albumin per PICU admission significantly decreased by 82%. In terms of patient characteristics and balancing measures, the 3 periods were not different. Stepwise quality improvement interventions, including the system change with the elimination of the 5% albumin inventory from the PICU, were effective in reducing 5% albumin use in the PICU with sustained reduction.

Serum Albumin as Independent Predictor In Determining The Outcome Of Traumatic Brain Injury

Context: Serum albumin is the major protein of the human plasma, accounting for about 60% of the total plasma protein. Serum albumin levels tend to decline in the plasma due to injury or infection independent of nutritional status. Serum albumin consumption increases in a state of stress. Reduction in serum albumin occurs with intracranial haemorrhages. In a patient with severe head injury, there is a significant decline in serum albumin leading to hypoalbuminemia. Serum albumin can be used as an outcome marker in various critical illnesses, including traumatic brain injury. Aim: To determine that serum albumin is an independent predictor affecting the outcome of patients with severe traumatic brain injury over a 6-month duration Settings and design: This was conducted as prospective cohort study in two neurosurgical centres in the East Coast of Malaysia from June 2020 to June 2021 Subjects and methods: A total of fifty-five patients were admitted to our emergency intensive care, or high dependency unit with varying degrees of severe head injuries. Forty patients fulfilled the inclusion criteria of our study and were recruited for data collection and further analysis. Their serum albumin levels were drawn, analysed, and recorded. Statistical analysis used: Descriptive, univariate and multivariate analyses using Multiple Logistic Regression model were done using SPSS version 26.0. Results: Average age for patients in this study was 42 years old. 87.5% of patients involved in this study were male, while the remaining 12.5% were female. The ethnicity of the majority of patients were Malays (77.5%) and the other ethnicities involved were Chinese, Indians and Bangladeshi, with a total of 22.5%. Multiple intracranial injuries were suffered by 57.5% of our study population, Subdural Hemorrhage, Extradural Hemorrhage, Contusional bleed, and Diffuse Axonal Injury were seen respectively in 20%, 10% 7.5% and 5% of the study population. At six months, the unfavourable outcome for serial serum albumin in patients with severe head injury patients was 62.5%, while the favourable outcome was 37.5%. Serum albumin of 30 g/L or less than 30g/L at day 1,3 and 5 post-trauma was noted to have unfavourable outcomes compared to serum albumin level of more than 30g/L. Conclusion: Serum albumin is an independent predictor of outcome in severe TBI patients. However, larger prospective studies are required to verify these findings.

The Impact of Clinical Pharmacist Implemented Protocol on Albumin Utilization and Cost in an Intensive Care Unit in Egypt.

Introduction: Albumin is an expensive non-blood plasma substitutes with limited availability that has been reported to be inappropriately used in healthcare settings. Hence, interventions are recommended to control its misuse. Objective: To evaluate the impact of clinical pharmacist implemented dispensing protocol on optimization of albumin use in an intensive care unit (ICU). Design: A retrospective prospective 3-phase interventional study was conducted in an ICU in a tertiary Egyptian hospital over a period of 2 years. Methods: The study included three phases; a preparation phase where a local albumin dispensing protocol and a restriction dispensing form were prepared by clinical pharmacists and was approved by the local Drugs and Therapeutics Committee, a retrospective pre-implementation phase in which the medical records of all ICU patients receiving albumin were evaluated for appropriateness of albumin use according to the developed protocol, and a prospective implementation phase where the dispensing protocol and restriction dispensing form were applied. The pattern of albumin consumption and cost were recorded and compared between the retrospective and prospective phases. Results: In the retrospective phase, 190 ICU patients received albumin of whom 83.6% was considered inappropriate indications for albumin compared to only 44 patients in the prospective phase of whom 16% was considered inappropriate (p-value <0.001). Clinical pharmacists’ interventions significantly decreased the inappropriate albumin consumption from 4.7 vials/patient in the retrospective phase to 2.7 vials/patient in the prospective phase (p-value <0.001) with a total cost savings of 313,900 Egyptian Pounds (19,930 US Dollars). Conclusion: The current study showed that clinical pharmacists’ interventions led to a significant control on albumin use and consequently reduced the cost associated with its consumption.

Pattern of albumin consumption in patients hospitalized in intensive care unit of two teaching hospitals in Iran

Aims: The goal of this study was to evaluate the consumption pattern of human albumin according to the available and reliable guidelines. Methods: This research was a descriptive-analytical study. The study sample consisted of patients admitted to the intensive care units (ICUs) of Shahid Sadoughi and Rahnemoon Yazd Teaching Hospitals. In this study, 67 patients were selected. The study was carried out over three months. During the study, the albumin request by ICUs was investigated. Along with observing albumin orders' para-clinic findings were evaluated. The specific form of albumin consumption and prescription prepared by the Hospital Steering Board of Pharmacy was completed for each patient individually. Results: In this study, 65.7% of prescribed albumin was infused for approved cases by the US food and drug administration (FDA). Administration after burn injury with 32.8% and hypoalbuminemia with 19.4% of cases were the most frequently reasonable prescribed albumin. About 34.3% of prescribed albumin (18 cases) did not have FDA-approved indications. Albumin infusion after patients edema in 14.9% of cases, nutritional support 6 % and Major surgery 6% have been the most frequently incorrect prescribed albumin. Conclusion: Based on the findings of this study, the prescription of albumin in patients admitted to ICUs of Sadoughi and Rahnemoon teaching hospitals from October to December 2015 was not completely in accordance with the guidelines. So , consulting with relevant health care professionals can be helpful to improve the proper administration of this essential and expensive drug.

Expert consensus on the use of human serum albumin in critically ill patients.

Expert consensus on the use of human serum albumin in critically ill patients.

Neonatal Fc receptor induces intravenous immunoglobulin growth suppression in Langerhans cell histiocytosis.

The neonatal Fc receptor (FcRn) plays a role in trafficking IgG and albumin and is thought to mediate intravenous immunoglobulin (IVIG) therapy for certain diseases. IVIG can be used for the treatment of human Langerhans cell histiocytosis (LCH); however, the mechanism remains unclear. The expression and function of FcRn protein have not been studied in LCH, though the expression of FcRn messenger RNA (mRNA) have been reported. In this report, we confirmed the expression of FcRn in 26 of 30 pathological cases (86.7%) diagnosed immunohistochemically as LCH. The expression was independent of age, gender, location, multi‐ or single‐system, and the status of BRAFV600E immunostaining. We also confirmed the expression of FcRn mRNA and protein in the human LCH‐like cell line, ELD‐1. FcRn suppressed albumin consumption and growth of IVIG preparation‐treated ELD‐1 cells, but not of IVIG preparation‐untreated or FcRn‐knockdown ELD‐1 cells. In addition, FITC‐conjugated albumin was taken into Rab11‐positive recycle vesicles in mock ELD‐1 cells but not in FcRn‐knockdown ELD‐1 cells. IVIG preparation prolonged this status in mock ELD‐1 cells. Therefore, ELD‐1 recycled albumin via FcRn and albumin was not used for metabolism. Our results increase our understanding of the molecular mechanism of IVIG treatment of LCH.

The impact of a guideline to prevent inappropriate albumin administration in a hospital in Iran

Background/Aims In Iran, there are no specific national guidelines for the prescription or administration of albumin. Since March 2017, a standard guideline for albumin prescription has been implemented at a hospital in Tehran, Iran. The objective of this study was to compare the use of albumin and its related costs before and after implementation of this guideline. Methods A cross-sectional study was performed at the hospital in 2018. Data regarding albumin prescription were collected using a census method. Collected data included the demographic and clinical information of patients, duration of hospitalisation and the costs of tests and pharmacotherapy consultations before albumin was prescribed. Albumin consumption costs were also collected before and after the implementation of the guideline. Data were analysed using SPSS 21 software and descriptive statistics. Results Albumin consumption was significantly reduced after the guideline was implemented, decreasing from an average of 28 vials (289g) to an average of 6 vials (67g) per patient. The average cost of albumin use also fell from the equivalent of $1218 before the guideline was implemented, to an average of $281 per patient. Conclusions The implementation of a guideline for albumin prescription and administration in a hospital setting resulted in a significant reduction of inappropriate albumin use and the associated costs.

Knowledge Acquisition: What Do Our Patients Receiving Peritoneal Dialysis Really Know about Albumin Consumption?

Patients receiving peritoneal dialysis historically have difficulty keeping albumin and phosphorus levels within therapeutic ranges on a consistent basis. The purpose of this quantitative study was to assess if patients receiving peritoneal dialysis had a working nutritional knowledge related to albumin levels and to determine if increasing egg consumption would result in an increase of albumin levels. This study was conducted using a prospective quantitative pre-test/post-test knowledge test and assessing the recorded pre-albumin and pre-phosphorus lab values from the electronic medical record, which are drawn each month, and compare them over a one-month period. A convenience sample collection was conducted among 30 adult individuals receiving peritoneal dialysis. Findings in this study suggest that education continues to be a key component for positive outcomes for this patient population.

Analysis of the effects of different nutritional support methods on postoperative recovery in patients with gastric cancer

Objective: To assess the effects of different nutritional support methods on postoperative recovery in patients with gastric cancer. Methods: 98 patients who received radical gastrectomy were divided into three groups: parenteral nutrition group (PN group) (n=36), early enteral nutrition group (EEN group) (n=33) and early oral feeding group (EON group) (n=29). Tolerance of enteral nutrition, postoperative recovery and economic indicators were compared. Results: The number of laparoscopic-assisted surgeries was 18, 17 and 25 in PN group, EEN group and EON group, respectively. There was no significant difference in sex, age and body mass index(BMI) among the three groups. Gastrointestinal function recovered slowly in 3 cases, including 2 cases in EEN group and 1 case in EON group. 1 case in EON group had abdominal hemorrhage. Median postoperative hospital stay in PN, EEN and EON group was 11.0, 11.0 and 8.0 days respectively, and significant reduction can be found in EON group(P<0.001). The complication rates were 30.5% (11 cases), 12.1% (4 cases), and 13.8% (4 cases), respectively, with no statistically significant difference(P=0.102). The median nutritional support costs for PN group, EEN group, and EON group were 4 543.3, 974.2, and 265.0 yuan, respectively. The median albumin consumption was 90.0, 40.0, and 0 g, respectively. The EON groups were significantly lower (P<0.001). The results of the laparoscopic assisted subgroup and the ones of whole group were consistent. Conclusion: Compared with parenteral nutrition and early enteral nutrition, early oral feeding can reduce the amount of albumin consumption, decrease the cost of nutrition support and shorten the average hospital stay after surgey without increasing the incidence of complications.

A retrospective study on risk factors associated with postoperative delirium in elderly patients with hip fracture

Objective To investigate the incidence and related risk factors of delirium in elderly patients with hip fracture. Methods From October 2014 to February 2017, 306 patients with femoral neck fracture or intertrochanteric fracture more than 65 years old underwent elective hip arthroplasty (hip arthroplasty, proximal femoral nail fixation) were retrospectively analyzed. Patients' general information was recorded: age, sex, body mass index (BMI), history of diabetes mellitus, history of coronary heart disease, cerebral infarction, preoperative biochemical tests, left ventricular ejection fraction, thrombosis of both lower extremities, intraoperative status (ASA score, NYHA heart function score, anesthesia, anesthesia time, etc.), perioperative blood transfusion, biochemical examination on the first day after surgery, perioperative albumin consumption, etc.; according to whether delirium happened after surgery, those patients were divided into delirium group and non-delirium Group and analyzed the incidence of postoperative delirium. Using univariate logistic regression analysis screened factors associated with postoperative delirium. The results were entered into the multivariate logistic regression analysis, screening the high risk factors for postoperative delirium. Results The incidence of delirium was 59(19.29%) after perioperative hip fracture, including 23 males and 36 females, ranging in age from 70 to 93 years with an average of (81.9±5.4) years. 247 cases had no delirium, including 81 males and 166 females, aged 65-96 years, with an average (76.4±8.1) years. The factors of age, length of hospital stay, days before surgery, preoperative hematocrit, perioperative albumin consumption, perioperative blood transfusion, preoperative leukocyte levels, preoperative albumin levels, preoperative creatinine, urea level, Mallampati classification (Markov grade), cardiac function score (NYHA score), ASA score, intraoperative blood loss, postoperative leukocyte level, left ventricular ejection fraction, previous cerebral infarction, history of coronary heart disease, and diabetes were statistically significant different; univariate logistic regression analysis showed that the factors of age, ASA score, history of diabetes mellitus, length of hospitalization, and perioperative albumin consumption were demonstrated to have relationship with the occurrence of postoperative delirium. Multivariate regression analysis showed that age, history of diabetes and ASA score are the high risk factors of postoperative delirium. Conclusion Age, history of diabetes mellitus and ASA score are risk factors of delirium in elderly patients with hip fracture. Those patients older than 75 years, with the history of diabetes mellitus or ASA score > 2 points were at higher risk of postoperative delirium, which prolongs hospitalization and increases protein consumption. Key words: Hip fractures; Aged; Delirium; Risk factors; Logistic models

Drug utilization evaluation of albumin in a teaching hospital of Mashhad, Iran: an interventional pre-post design study.

Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre-post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016. A guideline for proper indications of albumin, designed and finalized based on the physicians' comments, was implemented in Group 2. Main outcome measure The pattern of albumin consumption. Results Fifty patients were evaluated in each group. The implementation of the guideline resulted in reduction of improper albumin use from 62 to 57.5%, which was not statistically significant; however., it reduced inappropriate dose and duration of albumin therapy (55.5-16.7%), the number of consumed albumin vial, and the average cost for each patient (317.78±3.15-149.81±1.91 USD) significantly, as well. Conclusion This study illustrated that in this hospital in most cases, albumin was used inappropriately and at an alarming rate. This improved after the introduction of an evidence-based guideline. Moreover, guideline implementation resulted in significant cost reduction.

Loss of expression of the recycling receptor, FcRn, promotes tumor cell growth by increasing albumin consumption.

Tumor cells rely on high concentrations of amino acids to support their growth and proliferation. Although increased macropinocytic uptake and lysosomal degradation of the most abundant serum protein, albumin, in Ras-transformed cells can meet these demands, it is not understood how the majority of tumor cells that express wild type Ras achieve this. In the current study we reveal that the neonatal Fc receptor, FcRn, regulates tumor cell proliferation through the ability to recycle its ligand, albumin. By contrast with normal epithelial cells, we show that human FcRn is present at very low or undetectable levels in the majority of tumor cell lines analyzed. Remarkably, shRNA-mediated ablation of FcRn expression in an FcRn-positive tumor cell line results in a substantial growth increase of tumor xenografts, whereas enforced expression of this receptor by lentiviral transduction has the reverse effect. Moreover, intracellular albumin and glutamate levels are increased by the loss of FcRn-mediated recycling of albumin, combined with hypoalbuminemia in tumor-bearing mice. These studies identify a novel role for FcRn as a suppressor of tumor growth and have implications for the use of this receptor as a prognostic indicator and therapeutic target.

Blood transfusion, colloid therapy and the possible saving of albumin volumes during surgery: data analysis of the survey for certified hospitals of the Japanese Society of Anesthesiologists.

PurposeThird-generation hydroxyethyl starch (HES) 130/0.4 has a larger dose limitation (up to 50 mL/kg/day) than HES 70/0.5 (up to 1000 mL/day) which has been used in Japan for 40 years. The aim of this study was to survey the current intraoperative blood transfusion and volume therapy and to predict the possible reduction of intraoperative albumin consumption assuming further replacement by HES 130/0.4 using data obtained from a survey by the Japanese Society of Anesthesiologists (JSA), although HES130/0.4 was not launched in Japan during this survey period.MethodsIn a JSA survey conducted at JSA-certified hospitals, 12,856 patients with a certain amount of blood loss were analyzed for 1 month (April, 2012). The patients were divided into two groups—group A included patients aged ≥11 years and group B included patients aged <10 years. The possible lower volume of intraoperative albumin was calculated assuming that HES 130/0.4 was used up to a dose of 50 mL/kg.ResultsBlood loss (total 15,111 L; 15,057 L in group A and 54 L in group B) was treated with allogeneic transfusion (total 7970 L; 7893 L in group A and 77 L in group B) and auto-transfusion (total 1777 L; 1771 L in group A and 6 L in group B) in both groups (n = 11,670 and 119). Albumin (total 1391 L; 1376 L in group A and 15 L in group B), and HES 70/0.5 (total 7645 L; 7638 L in group A and 7 L in group B) were used in both groups (n = 10,850 and 116). Five percent and 4.4 % albumin (total 1189 L; 1180 L in group A and 9 L in group B) could be replaced by HES 130/0.4 if HES 130/0.4 had been used up to a dose of 50 mL/kg.ConclusionBlood loss (15,111 L) was replaced with allogeneic transfusion (53 %), auto-transfusion (12 %), albumin (9 %) and HES 70/0.5 (51 %) during surgery in April 2012. The predicted volume of 5 and 4.4 % albumin saved during this 1-month period if HES 130/0.4 had been used up to a dose of 50 mL/kg was 1189 L (86 % of actual amount used).

DI-046 Albumin usage study

BackgroundA previous albumin use study had shown that consumption was continually increasing.PurposeTo evaluate the effect of an update in albumin use guidelines and recommendations in our hospital.Materials and methodsWe conducted...

How albumin administration for cirrhosis impacts on hospital albumin consumption and expenditure

To assess the impact of guidelines for albumin prescription in an academic hospital, which is a referral center for liver diseases. Although randomized trials and guidelines support albumin administration for some complications of cirrhosis, the high cost of albumin greatly limits its use in clinical practice. In 2003, a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital (Bologna, Italy) used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first- or second-line treatment. Indications in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis, and treatment of hepatorenal syndrome and refractory ascites. Although still debated, albumin administration in refractory ascites is accepted by the Italian health care system. We analyzed albumin prescription and related costs before and after implementation of the new guidelines. While albumin consumption and costs doubled from 1998 to 2002, they dropped 20% after 2003, and remained stable for the following 6 years. Complications of cirrhosis, namely refractory ascites and paracentesis, represented the predominant indications, followed by major surgery, shock, enteric diseases, and plasmapheresis. Albumin consumption increased significantly after guideline implementation in the liver units, whereas it declined elsewhere in the hospital. Lastly, extra-protocol albumin prescription was estimated as < 10%. Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.

Effects of Wheat Albumin Consumption on Expression of Genes Related to Lipogenesis and Insulin Sensitivity in Adipose Tissues of Rats

Suppression of postprandial hyperglycemia reduces lipogenic enzyme activities in the adipose tissues of normal rats. The present study investigated the expression of genes related to lipogenesis and insulin sensitivity in mesenteric adipose and epididymal adipose tissues to evaluate the effects of wheat albumin (WA) and a crude preparation of WA (CWA) with alpha-amylase inhibitory activity on lipid metabolism. Rats fed 2.5% WA, which had 12.7-fold inhibitory activity compared with CWA, exhibited reduced mRNA levels for G6PDH, ACO, ACS, PEPCK, and LPL in the mesenteric adipose, but not in the epididymal adipose tissue. Linear regression analyses showed that the gene expression levels of FAS, G6PDH, ACS, and LPL were reduced in dose-dependent manners in the mesenteric adipose tissue of rats fed the CWA diet. These results suggest that supplementation with CWA as well as WA reduces the expression of genes related to lipogenesis and insulin sensitivity in mesenteric adipose tissue.

Use of albumin in three French university hospitals: is prescription monitoring still useful in 2004?

Use of albumin (indications and quantities involved) has not been assessed in France since major changes occurred after the publication of Cochrane group meta-analysis. The objectives of this study were to measure the repartition of albumin indications in three French university hospitals in 2004 and to assess the feasibility and usefulness to implement a prescription-monitoring program. Exhaustive record of albumin prescription during 2 months in three French university hospitals of Marseille. Inclusion of all patients with a first prescription of albumin between 15 March 2004 and 15 May 2004. Indication, formulation and quantity prescribed were recorded for each prescription. One hundred and eighty-seven patients received a total of 426 prescriptions for a total quantity of 21 094 g of albumin during the study. The first indications were hypoalbuminemia (33% of total quantity), plasmapheresis (30.2%) and ascites or hepatorenal syndrome (13.7%). Fifty per cent of total quantity was used by 14 patients (7.5% of included patients). Most of albumin consumption in our study is concentrated on recognized indications or indications without alternative to albumin. The different levels of analysis (number of patient treated, number of prescription and quantities used) must be taken into account when analyzing medications such as albumin. Only a marginal proportion of consumption is expected to be saved with close monitoring of indications.

Exposure to Therapeutic Concentrations of Ritonavir, but Not Saquinavir, Reduces Secreted Aspartyl Proteinase of Candida parapsilosis

The effect of ritonavir and saquinavir, HIV proteinase inhibitors, on the secreted aspartyl proteinase (Sap) activity of Candida parapsilosis was studied. In a proteinase-inducing medium (yeast carbon base-bovine serum albumin), Sap activity in all clinical isolates of C. parapsilosis (n = 20) was observed at 37°C but not at 22°C. The presence of ritonavir at a concentration of 8 µg/ml produced an inhibition close to 50% albumin consumption and also delayed yeast growth; however, saquinavir did not have any effect on growth or on Sap activity. In Sabouraud broth, which does not induce Sap production, no effect was shown on yeast growth by either of the two HIV proteinase inhibitors studied.