Hypoalbuminemic Patients Research Articles

Role of albumin in the metabolism and excretion of ochratoxin A.

Ochratoxin A (OTA) is known to be strongly bound to serum albumin, but it remains unknown how albumin affects its metabolism and kinetics. To close this gap, we used a mouse model, where heterozygous albumin deletion reduces serum albumin to concentrations similar to hypoalbuminemic patients and completely eliminates albumin by a homozygous knockout. OTA and its potential metabolites (OTα, 4-OH-OTA, 7'-OH-OTA, OTHQ, OP-OTA, OTB-GSH, OTB-NAC, OTB) were time-dependently analyzed in plasma, bile, and urine by LC-MS/MS and were compared to previously published hepatotoxicity and nephrotoxicity data. Homozygous albumin deletion strongly accelerated plasma clearance as well as biliary and urinary excretion of the parent compound and its hydroxylation products. Decreasing albumin in mice by the heterozygous and even more by the homozygous knockout leads to an increase in the parent compound in urine which corresponded to increased nephrotoxicity. The role of albumin in OTA-induced hepatotoxicity is more complex, since heterozygous but not homozygous nor wild-type mice showed a strong biliary increase in the toxic open lactone OP-OTA. Correspondingly, OTA-induced hepatotoxicity was higher in heterozygous than in wild-type and homozygous animals. We present evidence that albumin-mediated retention of OTA in hepatocytes is required for formation of the toxic OP-OTA, while complete albumin elimination leads to rapid biliary clearance of OTA from hepatocytes with less formation of OP-OTA. In conclusion, albumin has a strong influence on metabolism and toxicity of OTA. In hypoalbuminemia, the parent OTA is associated with increased nephrotoxicity and the open lactone with increased hepatotoxicity.

The Effect of Albumin Replacement on Vasopressor Duration in Septic Shock in Patients With Hypoalbuminemia.

The use of albumin resuscitation in septic shock is only recommended in patients who have received large volumes of crystalloid resuscitation regardless of serum albumin concentration. The role of albumin is still largely debated and evidence to support its use still lacking. The objective of this study was to evaluate whether albumin replacement increases the number of vasopressor-free days in patients with septic shock and hypoalbuminemia. A retrospective analysis was conducted to assess the effect of albumin replacement in septic shock. Hypoalbuminemic patients with septic shock who received albumin were retrospectively compared with a cohort who did not. The primary outcome was number of vasopressor-free days at day 14 from shock presentation, which was analyzed using an adjusted linear regression model to adjust for confounders. There was no difference in vasopressor-free days at day 14 in patients who received albumin versus those who did not, after adjusting for confounders of exposure (0.50, 95% CI = -0.97 to 1.97; P = 0.502). There also was no difference in secondary outcomes except for need for invasive mechanical ventilation (MV), which was significantly lower in patients who received albumin (61 [54.4%] vs 88 [67.7%]; P = 0.035). We observed no difference in vasopressor-free days at day 14 in patients with hypoalbuminemia who received albumin compared with those who did not. However, patients who received albumin required significantly less MV although further studies are warranted to assess this effect.

Quantifying pH-induced changes in plasma strong ion difference during experimental acidosis: clinical implications for base excess interpretation.

It is commonly assumed that changes in plasma strong ion difference (SID) result in equal changes in whole blood base excess (BE). However, at varying pH, albumin ionic-binding and transerythrocyte shifts alter the SID of plasma without affecting that of whole blood (SIDwb), i.e., the BE. We hypothesize that, during acidosis, 1) an expected plasma SID (SIDexp) reflecting electrolytes redistribution can be predicted from albumin and hemoglobin's charges, and 2) only deviations in SID from SIDexp reflect changes in SIDwb, and therefore, BE. We equilibrated whole blood of 18 healthy subjects (albumin = 4.8 ± 0.2 g/dL, hemoglobin = 14.2 ± 0.9 g/dL), 18 septic patients with hypoalbuminemia and anemia(albumin = 3.1 ± 0.5 g/dL, hemoglobin = 10.4 ± 0.8 g/dL), and 10 healthy subjects after in vitro-induced isolated anemia (albumin = 5.0 ± 0.2 g/dL, hemoglobin = 7.0 ± 0.9 g/dL) with varying CO2 concentrations (2-20%). Plasma SID increased by 12.7 ± 2.1, 9.3 ± 1.7, and 7.8 ± 1.6 mEq/L, respectively (P < 0.01) and its agreement (bias[limits of agreement]) with SIDexp was strong: 0.5[-1.9; 2.8], 0.9[-0.9; 2.6], and 0.3[-1.4; 2.1] mEq/L, respectively. Separately, we added 7.5 or 15 mEq/L of lactic or hydrochloric acid to whole blood of 10 healthy subjects obtaining BE of -6.6 ± 1.7, -13.4 ± 2.2, -6.8 ± 1.8, and -13.6 ± 2.1 mEq/L, respectively. The agreement between ΔBE and ΔSID was weak (2.6[-1.1; 6.3] mEq/L), worsening with varying CO2 (2-20%): 6.3[-2.7; 15.2] mEq/L. Conversely, ΔSIDwb (the deviation of SID from SIDexp) agreed strongly with ΔBE at both constant and varying CO2: -0.1[-2.0; 1.7], and -0.5[-2.4; 1.5] mEq/L, respectively. We conclude that BE reflects only changes in plasma SID that are not expected from electrolytes redistribution, the latter being predictable from albumin and hemoglobin's charges.NEW & NOTEWORTHY This paper challenges the assumed equivalence between changes in plasma strong ion difference (SID) and whole blood base excess (BE) during in vitro acidosis. We highlight that redistribution of strong ions, in the form of albumin ionic-binding and transerythrocyte shifts, alters SID without affecting BE. We demonstrate that these expected SID alterations are predictable from albumin and hemoglobin's charges, or from the noncarbonic whole blood buffer value, allowing a better interpretation of SID and BE during in vitro acidosis.

Human serum albumin binds spike protein and protects cells from SARS-CoV-2 infection by modulating the RAS pathway

Since the start of the pandemic, scientists have directed their research towards identifying COVID-19 risk factors and predictive elements. Numerous clinical studies have established a strong connection between hypoalbuminemia and an unfavorable prognosis for COVID-19. Here, we aim to explore the impact of human serum albumin (HSA) on SARS-CoV-2 infection. Our findings indicate that HSA plays a role in reducing the replication rate of SARS-CoV-2 in Vero E6 cells. This protective effect is due to HSA ability to bind to the S1 domain of the spike protein, effectively competing with ACE2. Moreover, we show that the protective role of HSA is dependent also on its ability to activate the protective axis within the RAS system pathway, which is responsible for inducing vasodilation and promoting anti-inflammatory, anti-fibrotic, and anti-apoptotic responses. In summary, the data presented in this study support the idea that reduced levels of circulating HSA in hypoalbuminemic patients may heighten their susceptibility to SARS-CoV-2 infection, as the spike protein is unhindered in its ability to bind to ACE2 and penetrate human cells. Besides, hypoalbuminemia exacerbates the imbalance of the RAS pathway towards the classical “detrimental” axis. This could potentially contribute to the increased severity and elevated mortality rate observed in individuals with low levels of circulating albumin.

An Effect of Giving Snakehead Fish Extract ( Channa striata ) on Albumin, Neutrophil, and Lymphocyte Levels in Hypoalbuminemia Patients

Background : Hypoalbuminemia is a condition where the albumin level in the blood falls below normal. Hypoalbuminemia is known as a marker of protein energy malnutrition, inflammation, infection, liver disease, kidney disease and postoperative stress. In Indonesia, malnutrition hospital data shows 40-50% of patients have hypoalbuminemia or are at risk of hypoalbuminemia, 12% of them are severe hypoalbuminemia, and the hospitalization period for patients with hospital malnutrition shows 90% longer than patients with good nutrition. Decreased albumin levels can be associated with a decrease in the immune system and slow healing of tissues/wounds due to infection. Neutrophils and lymphocytes whose numbers increase when inflammation occurs. Oral administration of high protein with snakehead fish extract ( Channa striata ) is an alternative treatment for hypoalbuminemia. Objective: The purpose of this study was to determine the effect of snakehead fish extract (Channa striata) on albumin, neutrophil, and lymphocyte levels in hypoalbuminemic patients. Method: Articles are compiled using a systematic method literature review , involving national and international journals by taking journals through Google scholar, Pubmed, Research Gate, Scient direct. Results: There was an effect of giving snakehead fish extract on albumin levels, neutrophil values, and lymphocyte values in hypoalbuinemic patients and experimental animals. Conclusion: The content of amino acids, albumin, Zn, Fe, Cu and unsaturated fatty acids in snakehead fish ( Ophiocephalus striatus) is quite effective as an effort to increase albumin levels, decrease neutrophil and lymphocyte values when inflammation occurs in hypoalbuminemic patients.&#x0D; &#x0D; Keywords: Channa striata extract , Albumin, Neutrophils, Lymphocytes, Hypoalbuminemia

Ertapenem Versus Meropenem for the Treatment of Extended Spectrum Beta-Lactamase-Producing Enterobacterales Bacteremia in Critically Ill Patients.

The preferred carbapenem for treatment of infections caused by extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E) in critically ill patients is debated. The purpose of this study was to evaluate the difference in clinical failure between ertapenem and meropenem for treatment of ESBL-E bacteremia in critically ill patients. Of concern is ertapenem use in hypoalbuminemia given the potential for higher drug clearance. This retrospective, matched cohort study compared critically ill patients treated with ertapenem or meropenem for ESBL-E bacteremia between October 2016 and August 2022. Patients were matched on age, sex, lowest albumin, and in a 1:2 ratio of ertapenem to meropenem. The primary outcome, clinical failure, was a composite of 30-day mortality, antibiotic escalation, and microbiological failure. Secondary outcomes included all-cause readmission and development of superinfection. Of 54 patients, 18 received ertapenem and 36 meropenem. Most had a urinary infection source (55.6% vs 41.7%, P = 0.393). There was no difference in clinical failure (50.0% vs 38.9%, P = 0.436). Ertapenem patients had antibiotic escalation more often (33.3% vs 2.8%, P = 0.002). There was no difference in 30-day mortality (11.1% vs 27.8%, P = 0.298), microbiological failure (27.8% vs 11.1%, P = 0.142), all-cause readmission (22.2% vs 13.9%, P = 0.461), or development of superinfection (11.1% vs 13.9%, P = 1.000). There was no difference in clinical failure in a small, retrospective cohort of critically ill patients receiving ertapenem or meropenem for ESBL-E bacteremia. Ertapenem may be appropriate in some critically ill and hypoalbuminemic patients, though additional data are needed.

Human Albumin Infusion in Critically Ill and Perioperative Patients: Narrative Rapid Review of Meta-Analyses from the Last Five Years.

Human albumin, a vital plasma protein with diverse molecular properties, has garnered interest for its therapeutic potential in various diseases, including critical illnesses. However, the efficacy of albumin infusion in critical care and its associated complications remains controversial. To address this, a review of recent meta-analyses was conducted to summarize the evidence pertaining to albumin use in critical illness. Adhering to the rapid review approach, designed to provide a concise synthesis of existing evidence within a short timeframe, relevant meta-analyses published in the last five years were identified and analyzed. PubMed, Embase, and Cochrane databases of systematic reviews were searched using pre-defined search terms. Eligible studies included meta-analyses examining the association between albumin infusion and outcomes in critically ill and perioperative patients. Twelve meta-analyses were included in the review, covering diverse critical illnesses and perioperative scenarios such as sepsis, cardiothoracic surgery, and acute brain injury. The analyses revealed varying levels of evidence for the effects of albumin use on different outcomes, ranging from no significant associations to suggestive and convincing. Albumin infusion stabilizes hemodynamic resuscitation endpoints, improves diuretic resistance, and has the potential to prevent hypotensive episodes during mechanical ventilation in hypoalbuminemic patients and improve the survival of patients with septic shock. However, caution is warranted due to the methodological limitations of the included studies. Further high-quality research is needed to validate these findings and inform clinical decision-making regarding albumin use in critical care.

Hypoalbuminemia, body mass index, and weight loss as predictors of outcomes in head and neck cancer.

e18027 Background: Malnutrition is a major complication of head and neck cancer and has pertinent implications on survival. Methods: We performed a retrospective analysis of 320 patients with head and neck cancer from a tertiary hospital in Western Australia from 2013 - 2021. Weight and albumin were collected from different timepoints in the patient’s journey, including at diagnosis and end of treatment. Treatments received, recurrences and survival data were also collected. Initial univariate analyses were performed using Chi squares. Results: Median follow-up was 2.6 years (range 16 days to 9 years). 44% of patients underwent curative intent radiotherapy or chemoradiotherapy, 38% had surgery (+/- adjuvant therapies), 9% had palliative treatments, and 9% had best supportive care. At diagnosis, 12% of patients were hypoalbuminemic, 75% had normal albumin, and albumin was unknown in 13%. Hypoalbuminemia at diagnosis strongly correlated with lower survival compared with patients with normal albumin with 1 year OS (1YS) 35% vs 82% (p &lt; 0.00001). Patients with normal albumin at diagnosis had higher disease-free survival compared to hypoalbuminemic patients (56% vs 32%, p = 0.04). By the end of treatment, 22% of patients were hypoalbuminemic, 48% had normal albumin, and 30% were unknown. Hypoalbuminemia at end of treatment was also prognostic, with 1YS 72% vs 89% and 2YS 52% vs 72% (p = 0.002) when compared to patients with normal albumin. Of patients who were treated with curative intent, there was no significant difference in the rate of relapse (38% vs 35%, p = 0.67). By Body Mass Index (BMI) at diagnosis, 5% of patients were severely underweight (BMI &lt; 16.5), 7% underweight (BMI 16.5-18.4), 34% healthy (BMI 18.5-24.9), 31% overweight (BMI 25.0-29.9), and 22.5% obese (BMI ≥30). BMI at diagnosis was highly prognostic with 1YS 37% in severely underweight patients, 67% underweight, 75% healthy, 91% overweight, and 94% in obese individuals (p &lt; 0.00001). By end of treatment, 7% were severely underweight, 9% were underweight, 42% were healthy, 28% were overweight, and 14% were obese. Low BMI at end of treatment was also associated with inferior outcomes with 1YS 53% in severely underweight individuals, 76% underweight, 83% healthy, 97% overweight, and 95% in obese patients (p &lt; 0.00001). Median weight loss from diagnosis to end of treatment was 6kg (range from 34kg loss to 15kg gain), and median % body weight change was -7.5% (range from -28% to +26%). Percentage body weight loss of &gt; 20% was associated with worse survival with 65% mortality during the study period compared with 35% in patients who lost ≤20% body weight. 1YS was 71% in patients who lost &gt; 20% body weight compared to 86%, although this did not reach statistical significance (p = 0.097). Conclusions: Hypoalbuminemia and low BMI at diagnosis and end of treatment, in addition to % body weight loss of &gt; 20% were all associated with worse survival in head and neck cancer patients.

Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method

Objective: To evaluate the effect of low serum Albumin levels on serum sodium measurement when analyzed by the indirect Ion Selective Electrode (ISE) method and to compare the results with the direct Ion selective electrode (ISE) method.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan to Mar 2021.&#x0D; Methodology: Patients of either gender, aged 18 to 70 years, who were admitted to the Intensive Care Unit of Combined Military Hospital, Rawalpindi, were selected. A total of 200 blood samples were collected in a gel tube. Serum samples were analyzed for albumin and sodium within two hours of sample collection. Sodium levels were measured concurrently by both direct and indirect ISE methods. The difference in results between these two techniques was studied.&#x0D; Results: Hypoalbuminemia was detected in 176(88%) patients, while 24(12%) had normal albumin levels. In Hypoalbuminemic patients, serum sodium measurements were higher using the indirect ISE method(134.07±5.55) compared to the direct ISE method (130.95±6.04); the difference between the two techniques was statistically significant (p-value &lt;0.001).Pearson correlation coefficient (r-value = -0.86, p-value &lt;0.001) revealed a symmetrical increase in differences between the two methods as the albumin level decreased.&#x0D; Conclusion: In Hypoalbuminemic patients, the indirect ISE method gave falsely raised results of serum sodium. In such patients, serum sodium measurement by the Direct ISE method offers more accurate and consistent electrolyte results.

Hypoalbuminemia as a Predictor of Mortality, Disability, and Readmission in Patients Undergoing Spine Surgery: A Retrospective Analysis.

This was a retrospective cohort study. The objective of this study was to clarify the association between preoperative albumin status and mortality and morbidity in lumbar spine surgery. Hypoalbuminemia is a known marker of inflammation and is associated with frailty. Hypoalbuminemia is an identified risk factor for mortality following spine surgery for metastases, yet has not been well studied among spine surgical cohorts outside of metastatic cancer. We identified patients with preoperative serum albumin laboratory values who underwent lumbar spine surgery at a US public university health system between 2014 and 2021. Demographic, comorbidity, and mortality data were collected along with preoperative and postoperative Oswestry Disability Index (ODI) scores. Any cause readmission within 1 year of surgery was recorded. Hypoalbuminemia was defined as <3.5g/dL in serum. We examined the Kaplan-Meier survival plots based on serum albumin. Multivariable regression models were used to identify the association between preoperative hypoalbuminemia with mortality, readmission, and ODI, while controlling for age, sex, race, ethnicity, procedure, and Charlson Comorbidity Index. Of 2573 patients, 79 were identified as hypoalbuminemic. Hypoalbuminemic patients had a significantly greater adjusted risk of mortality through 1 year (odds ratio=10.2; 95% CI: 3.1-33.5; P <0.001), and 7 years (hazard ratio=4.18; 95% CI: 2.29-7.65; P <0.001). Hypoalbuminemic patients had ODI scores 13.5 points higher (95% CI: 5.7-21.4; P <0.001) at baseline. Adjusted readmission rates were not different between groups through 1 year (odds ratio=1.15; 95% CI: 0.5-2.62; P =0.75) or through full surveillance (hazard ratio=0.82; 95% CI: 0.44-1.54; P =0.54). Preoperative hypoalbuminemia was strongly associated with postoperative mortality. Hypoalbuminemic patients did not have demonstrably worse outcomes in their functional disability beyond 6 months. Within the first 6 months following surgery, the hypoalbuminemic group improved at a similar rate to the normoalbuminemic group despite having a greater preoperative disability. However, causal inference is limited in this retrospective study.

Preoperative Hypoalbuminemia as a Predictor of Severe Postoperative Complications in Patients Undergoing Whipple Pancreatoduodenectomy.

Pancreaticoduodenectomy (PD) known as Whipple procedure is still one of the most complex abdominal surgeries used for treatment of periampullary tumors. PD is often followed with postoperative complications (pancreatic, biliar or intestinal fistula, haemorrhage, intraabdominal abscess, delayed gastric empting. Severe postoperative complications (SPC) can be reason for reoperation and reason of bad outcome of treatment and life treathening condition. To investigate predicitive value of preoperative hypoalbuminemia for severe postoperative complications (SPC) in patients who have undergone Whipple pancreaticoduodenetomy (PD). However, no similiar study has been ever reported from our country until now. In this retrospective-prospective study, 100 patients who have had Whipple pancreaticoduodenectomy for malignant periampullary tumors at the Department for Surgery of University Clinic Center Tuzla, Bosnia and Herzegovina were enrolled, from january of 2009 to decembre of 2021. All patients were preoperatively analysed according to serum albumine levels and presensce of hypolabuminemia (serum albumine levels <32g/l). Serum albumine biochemical test were done 1-2 days preoperatively. Clavien Dindo classification was used for determination patients with SPC. Patients who did not have SPC belonged to (I-II) Clavien Dindo group of patients while those who had SPC belonged to( III-V) Clavien Dindo group of patients. Out of 100 patients who have undergone pancreaticoduodenetomy, in 55 (55%) patients postoperative complications were noticed. Mortality rate was 18 (18%) and reoperation has been done in 20 cases (20%). SPC were noticed in 19 patients and most often were: delayed gastric emptying (20%), pancreatic fistula (13%) and intraabdominal collections (9%). Hypoalbuminemic patients had a significantly higher rate of severe postoperative complications ( p<0.05). Using hypoalbuminemia-SPC correlation analaysis, there is confirmed statistically significant correlation between hypoalbuminemia and SPC (ρ= 0.236; p<0.05). Preoperative hypoalbuminemia can be used as predictor and prognostic factor for severe postoperative complications after Whipple pancreaticoduodenectomy. Identification and optimization of serum albumin level prior to Whipple pancreatoduodenectomy may improve surgical outcomes.

Comparison of Llevel of improvement in serum albumin after protein supplementation verses standard treatment in patients on maintenance hemodialysis.

Background: Hemodialysis has been shown to increase protein catabolism and led to significant loss of proteins during hemodialysis. Hypoalbuminemia has been associated with adverse outcomes. Therefore, the main aim of this study is to determine the effect of intradialytic protein supplementation on serum albumin in hemodialysis patients.&#x0D; Methods: 116 hypoalbuminemic patients, as defined by the operational definition, on twice per week hemodialysis, from 15.09.15 to 15.03.16, were enrolled after obtaining informed consent. A non-randomized control trial was conducted after dividing the study population was divided into 2 groups; the study group which received 20g oral protein supplementation and the control group which have not received any supplementation. Outcome in terms of improvement in serum albumin was recorded on a predesigned proforma. SPSS version 17 was used for analysis. Effect modifiers were controlled by stratification. Chi square test was used to compare improvement in serum albumin between two groups and also after post stratification.&#x0D; Results: There were total 49 male and 67 female patients. Mean age of total patients was 57.25 years. 94.1% of the patients showed improvement in serum albumin in the intervention group and 56.9% in the control group. Patients of both genders between 46 to 75years, and those dialyzed for a shorter duration showed significant improvement in serum albumin levels.&#x0D; Conclusion: As intradialytic oral protein supplementation significantly improved serum albumin levels, specifically in elderly patients, it is therefore recommended to routinely administer nutritional supplements in hypoalbuminemic hemodialysis patients in order to reduce the overall mortality associated with hypoalbuminemia.

Factors Affecting Readmission in Hospitalized Patients with Chronic Kidney Disease: a Single Center Study

Introduction: Chronic Kidney disease (CKD) in itself and the associated comorbidities together put the patients at increased risk of hospitalization. We aimed to study the factors associated with hospital readmission within 30 days of discharge in hospitalized patients with CKD. Methods: This was a single center descriptive observational study conducted in Tribhuvan University Teaching Hospital (TUTH), Kathmandu. Hospitalized CKD patients were evaluated for sociodemographic parameters, clinical profile and laboratory parameters; they were asked over the phone after 30 days of discharge if they had repeat hospitalization. Readmission rates were calculated and factors at admission associated with repeat hospitalization were analyzed. Results: Out of 337 CKD patients 307 could be contacted. Fifty patients (16.28%) needed readmission. Readmission rate was higher in patients older than 75 years and between ages 25 to 50. Patients who were undergoing dialysis at TUTH (OR 3.324 CI 1.239-8.917, p=0.017), who belonged to Newari community (OR 2.85 CI 1.17-6.9, p=0.020) and those from Kathmandu valley (1.94,CI 0.94-3.99) had higher odds of readmission. Hypertension, diabetes mellitus and tuberculosis as a comorbidity had increased odds of readmission of (1.51,CI 0.60-3.77), (1.48, CI 0.79-2.76), (1.569,CI 0.441-4.468) respectively. Hemoglobin less than 9 gm/dl and serum albumin less than 35 gm/l had higher odds of readmission of (1.109 95% CI 0.605-2.033) and (1.877,95%CI 0.869-4.054) respectively. Conclusion: Overall 30 day readmission rate of Hospitalized CKD patients was 16.28%. Elderlies, those with medical comorbiditites, anemic and hypoalbuminemic patients tended to have increased odds of readmission.

Effect of Giving Snakehead Fish Extract (Channa striata) on Albumin, Neutrophil, and Lymphocyte Levels in Hypoalbuminemia Patients

Hypoalbuminemia is a condition where the albumin level in the blood falls below normal. Hypoalbuminemia is known as a marker of protein energy malnutrition, inflammation, infection, liver disease, kidney disease and postoperative stress. In Indonesia, malnutrition hospital data shows 40-50% of patients have hypoalbuminemia or are at risk of hypoalbuminemia, 12% of them are severe hypoalbuminemia, and the hospitalization period for patients with hospital malnutrition shows 90% longer than patients with good nutrition. Decreased albumin levels can be associated with a decrease in the immune system and slow healing of tissues/wounds due to infection. Neutrophils and lymphocytes whose numbers increase when inflammation occurs. Oral administration of high protein with snakehead fish extract (Channa striata ) is an alternative treatment for hypoalbuminemia. Objective: The purpose of this study was to determine the effect of snakehead fish extract (Channa striata) on albumin, neutrophil, and lymphocyte levels in hypoalbuminemic patients. Method: Articles are compiled using a systematic method literature review , involving national and international journals by taking journals through Google scholar, Pubmed, Research Gate, Scient direct. Results: There was an effect of giving snakehead fish extract on albumin levels, neutrophil values, and lymphocyte values in hypoalbuinemic patients and experimental animals. Conclusion: The content of amino acids, albumin, Zn, Fe, Cu and unsaturated fatty acids in snakehead fish ( Ophiocephalus striatus) is quite effective as an effort to increase albumin levels, decrease neutrophil and lymphocyte values when inflammation occurs in hypoalbuminemic patients

Preoperative hypoalbuminemia in patients undergoing cardiac surgery: a meta-analysis.

The preoperative serum albumin level has been shown to be associated with adverse postoperative complications, meaning that hypoalbuminemia may also be a risk factor. We performed a meta-analysis to evaluate the association of serum albumin levels with survival and complication rates after cardiac surgery. Relevant articles were identified through seven databases. Twenty studies with 22553 patients (hypoalbuminemia group, n = 9903; normal group, n = 12650) who underwent cardiac surgery met the inclusion criteria after screening. The primary outcomes were that hypoalbuminemia was significantly correlated with serious long-term all-cause mortality (hazard ratio [HR]: 1.95 [1.54-2.48]; P < 0.00001) and increased mortality (risk ratio [RR] = 1.91 [1.61-2.27], P < 0.00001). Hypoalbuminemic patients with cardiopathy were more likely to suffer postoperative complications (bleeding, infections, renal injury, and others) than those whose serum albumin levels were normal. Furthermore, hypoalbuminemia increased the time in the intensive-care unit (ICU) (mean difference [MD] = 1.18 [0.49-1.87], P = 0.0008), length of hospital stay (LOS) (MD = 3.34, 95% CI: 1.88-4.80, P < 0.00001), and cardiopulmonary bypass time (CPB) (MD = 12.40 [1.13-23.66], P = 0.03). Hypoalbuminemia in patients undergoing cardiac surgery appears to have a poor all-cause mortality or increased risk of complications. Adjusted perioperative serum albumin levels and treatment strategies for this high-risk population have the potential to improve the survival.

The Effect of Exogenous Human Albumin Administration on Acute Kidney Injury Development in Hypoalbuminemic Patients in the Intensive Care Unit

The Effect of Exogenous Human Albumin Administration on Acute Kidney Injury Development in Hypoalbuminemic Patients in the Intensive Care Unit

Perbandingan Efektivitas Terapi Ekstrak Ikan Gabus Dengan Putih Telur Dan Human Albumin 20% Terhadap Peningkatan Kadar Albumin Pasien Hipoalbuminemia Di RSUD dr. Zainoel Abidin

Hypoalbuminemia is a condition where blood albumin levels are less than 3.5 g/dL. In this condition, there will be disruption to the physiological processes in the body. There is a relationship between low albumin levels with an increased risk of infectious complications, a high mortality rate in hospitalized patients, both non-surgical and surgical patients. To restore the important function of albumin, intervention is needed to increase albumin levels in the blood. Human albumin infusion is the most common. However, because of the high price, many other alternatives have been investigated to increase plasma albumin levels. This study aims to determine the effectiveness of snakehead fish extract therapy, compared with egg white and 20% human albumin in increasing albumin levels in hypoalbuminemic patients so that it can save costs and can improve the quality of life of hypoalbuminemia. This research is a quantitative research with Randomized Control Trial design. Samples were collected from August to October 2021 in the surgical inpatient ward of RSUD dr Zainoel Abidin. Data were collected from 36 samples, then divided into 3 treatment groups, namely the egg white group, the snakehead fish extract group and the Human Albumin group. The study used a randomized, blinded clinical trial. The data taken is albumin levels. The data were tested for normality with the Kolmogrov-Sminrnov test, then continued with the ANOVA test. The results obtained 36 samples that meet the inclusion criteria. The average level of increase in the egg white group was -0.0792 (Sig. 0.51), the snakehead fish extract group was 0.1625 (sig. 0.429) and the Human Albumin group was 0.237 (sig. 0.431). From the results of these studies giving snakehead fish extract can be an alternative therapy to treat hypoalbuminemia conditions.Keywords: Hypoalbuminemia, Albumin, Egg white, Snakehead Fish Extract, Human Albumin

Interpretation of plasma levels of phenytoin and vaproate administraded enterally in hypoalbuminemic female patient

Interpretation of plasma levels of phenytoin and vaproate administraded enterally in hypoalbuminemic female patient

Design and validation of a predictive equation to estimate unbound valproic acid concentration

ObjectivesTotal plasma levels of valproic acid (VPA) may mask an increased risk of adverse effects in hypoalbuminaemic patients since, in these patients, the free fraction is higher. The aim of...

Elevated serum thyrotropin levels and endothelial dysfunction in a prospective hemodialysis cohort.

Thyroid dysfunction is a highly prevalent yet under-recognized complication in hemodialysis patients. In the general population, hypothyroidism has been associated with endothelial dysfunction due to impaired vasodilator synthesis and activity. Little is known about the association of serum thyrotropin (TSH), the most sensitive and specific single biochemical metric of thyroid function, with endothelial function in hemodialysis patients. In a secondary analysis of 99 patients from the Anti-inflammatory and anti-oxidative nutrition in hypoalbuminemic dialysis patients (AIONID) trial, we examined measurements of serum TSH and endothelial function ascertained by fingertip digital thermal monitoring (DTM), a novel method used to measure micro-vascular reactivity, collected within a 90-day period. DTM was used to measure changes in fingertip temperature during and after an ischemic stimulus (blood pressure cuff occlusion) as an indicator of changes in blood flow, and two DTM indices were assessed, namely adjusted (a) Temperature Rebound (TR), defined as the maximum temperature rebound post-cuff deflation, and adjusted (b) Area Under the Temperature Curve (TMP-AUC), defined as area under the curve between the maximum and minimum temperatures. We examined the relationship between serum TSH with impaired TR (separately) and TMP-AUC (both defined as less than the median level of observed values) using multivariable logistic regression. In unadjusted and case-mix analyses, higher serum TSH levels (defined as the three highest quartiles) were associated with lower (worse) TR (ref: lowest TSH quartile): ORs (95% CI) 2.64 (1.01-6.88) and 2.85 (1.08-7.57), respectively. In unadjusted and case-mix analyses, higher TSH levels were associated with lower (worse) TMP-AUC: ORs (95% CI) 2.64 (1.01-6.88) and 2.79 (1.06-7.38), respectively. In HD patients, higher serum TSH levels were associated with worse micro-vascular reactivity measured by DTM. Further studies are needed to determine if thyroid hormone supplementation improves endothelial function in hemodialysis patients with lower levels of thyroid function.