HPE Human Albumin | Page 12

the intravascular space for longer time periods . 17 The colloids used in clinical use are classified into natural ( e . g ., human albumin ) and artificial , e . g ., hydroxyethyl starch ( HES ) or semi-synthetic , e . g ., gelatins . 17 Although hypovolemia leads to diminished organ perfusion and ultimately ischemia and organ failure , a further consideration with fluid replacement is the amount of fluid to administer ; too much or too little can impact patient outcomes . 17 In general , colloids have a greater plasma expanding effect than crystalloids ; in other words , it is possible to increase the intravascular volume with smaller amounts of fluid . 17 Although there is currently a lack of consensus over the use of crystalloids or colloids as a resuscitation fluid , there is much greater clarity over the use of synthetic colloids , in particular HES . Indeed , a review of the use of HES concluded that : “ with a lack of clear benefit from HES in any clinical setting and with safer alternatives such as crystalloids and albumin , HES should be avoided .” 19
Use in patients with cirrhosis and liver failure Albumin use in combination with antibiotic vs . antibiotic alone has been shown to reduce the incidence of renal impairment and mortality in patients with spontaneous bacterial peritonitis . 20 A systematic review of 45 randomized controlled trials and ten meta-analyses ( 1985 – 2000 ) showed that albumin is effective and superior to other plasma expanders in preventing and controlling the incidence of complications of cirrhosis . 21 Currently , albumin infusion is endorsed by European and American guidelines for prevention of renal injury during large volume paracentesis and as an adjuvant to antibiotics for management of spontaneous
22 , 23 bacterial peritonitis .
Given the potential benefits of albumin , in recent years increasing evidence has emerged pointing to the safety and efficacy of albumin , prompting its greater therapeutic use . 24 This growing interest has been driven , to some extent , by the recognition that hypoalbuminemia is associated with the acquisition and severity of bacterial , viral and fungal infections and ongoing studies will address the effects of albumin infusion on disease outcomes in patients with hypoalbuminemia . Indeed , hypoalbuminemia has been associated with worse outcome in patients hospitalized with COVID-19 , with one study showing that there was a 72 % reduced risk of developing venous thromboembolism among those with higher albumin levels . 25
A 2021 systemic review of hyper- and hypo-oncotic albumin has provided clear evidence of a beneficial effect in a range of clinical setting and conditions including pre- and post-surgery and pediatric , burn , and critically ill patients . 26
Conclusion Albumin is currently recommended where it has proven clinical benefits especially for sepsis and hypoalbuminemic septic shock and preventing the complications of liver cirrhosis . Albumin also appears to have clinical advantages beyond its use as a resuscitation fluid , especially in preservation of the glycocalyx which can be easily damaged in response to inflammation , trauma , and hemorrhagic shock and which precedes further damage to the vascular endothelium . While the evidence to date has been derived from where it has been shown to have a proven benefit on patient outcomes , ongoing studies such as the ARISS trial , 27 a prospective , randomized trial exploring the value of albumin replacement in patients with septic shock , will hopefully provide further and more robust evidence for the role of albumin therapy .
References 1 Rabbani G , Ahn SN . Structure , enzymatic activities , glycation and therapeutic potential of human serum albumin : A natural cargo . Int J Biol Macromol 2019 ; 123:979 – 90 . 2 Keaney JF Jr et al . NO forms an adduct with serum albumin that has endothelium-derived relaxing factor-like properties . J Clin Invest 1993 ; 91:1582 – 9 . 3 Bertucci C , Domenilo E . Reversible and covalent binding of drugs to human serum albumin : methodological approaches and physiological relevance . Curr Med Chem 2002 ; 9:1463 – 81 . 4 Inoue M et al . Mechanism of furosemide resistance an analbuminemic rats and hypoalbuminemic patients . Kidney Int 1987 ; 32:198 – 203 . 5 Goldwasser P , Feldman J . Association of serum albumin and mortality risk . J Clin Epidemiol 1997 ; 50 ( 6 ): 693 – 703 . 6 Zhang WJ , Frei B . Albumin selectively inhibits TNF alphainduced expression of vascular cell adhesion molecule-1 in
human aortic endothelial cells . Cardiovasc Res 2002 ; 55:820 – 9 . 7 Huet O et al . Oxidative stress and endothelia dysfunction during sepsis . Front Biosci 2011 ; 16:1986 – 95 . 8 Taverna M et al . Specific antioxidant properties of human serum albumin . Ann Intensive Care 2013 ; 3 ( 1 ): 4 . 9 Wiedermann CJ , Wiedermann W , Joannidis M . Hypoalbuminemia and acute kidney injury : a meta-analysis of observational clinical studies . Intensive Care Med 2010 ; 36:1657 – 65 . 10 Vincent JL , Navickis RJ , Wilkes MM . Morbidity in hospitalized patients receiving human albumin : a meta-analysis of randomized , controlled trials . Crit Care Med 2004:32:2029 – 38 . 11 Xu JY et al . Comparison of the effects of albumin and crystalloid on mortality in adult patients with severe sepsis and septic shock : a meta-analysis of randomized clinical trials . Crit Care 2014 ; 18 ( 6 ): 702 . 12 Martin GS , Bassett P . Crystalloids vs colloids for fluid
resuscitation in the intensive care unit : a systemic review and meta-analysis . J Crit Care 2019 ; 50:144 – 54 . 13 Hariri G et al . Albumin infusion improves endothelial function in septic shock pains : a pilot study . Intensive Care Med 2018 ; 44:669 – 71 . 14 Guidet B et al . Economic model of albumin infusion in septic shock : The EMAISS study . Acta Anaesthesiologica Scand 2020 ; 64 ( 6 ): 781 – 8 . 15 Rhodes A et al . Surviving sepsis campaign : international guidelines for management of sepsis and septic shock : 2016 . Intensive Care Med 2017 ; 43 ( 3 ): 304 – 77 . 16 Zhou S et al . Early combination of albumin with crystalloids administration might be beneficial for the survival of septic patients : a retrospective analysis from MIMIC-IV database . Ann Intensive Care 2021:11 ( 1 ): 42 . 17 MacDonald N , Pearse R . Are we close to the ideal intravenous fluid ? BJA 2017 ; 119 : i63 – 171 . 18 Lewis S et al . Colloids versus
crystalloids for fluid resuscitation in critically ill people ( Review ). Cochrane Database Sys Rev 2018 ; Issue 8 : CD000567 . 19 Unal MN , Reinhart K . Understanding the harms of HES : a review of the evidence to date . Turk J Anaesthesiol Reanim 2019 ; 47 ( 2 ): 81 – 91 20 Sort P et al . Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis . N Engl J Med 1999 ; 341 ( 6 ): 403 – 9 . 21 Zaccherini G , Tufoni M , Bernardi M . Albumin administration is efficacious in the management of patents with cirrhosis : a systematic review of the literature . Hepat Med 2020 ; 12:153 – 72 . 22 European Association for the Study of Liver . EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis . J Hepatol 2018 ; 69 ( 2 ): 406 – 60 . 23 Runyon B , AASLD . Introduction to the revised American Association for the Study of Liver Diseases Practice
Guideline management of adult patients with ascites due to cirrhosis 2012 . Hepatology 2013 ; 57 ( 4 ): 1651 – 3 . 24 Melia D , Post B . Human albumin solutions in intensive care : A review . J Intensive Care Soc 2020 . doi : 10.1177 / 1751143720961245 . 25 Kheir M et al . Higher albumin levels on admission predict better prognosis in patients with confirmed COVID-19 . PLoS One 2021 ; 16 ( 3 ): e02483558 . 26 Haynes GR , Bassiri K . Hyperoncotic vs hypo-oncotic albumin solutions : a systemic review of clinical efficacy and safety . SN Comp Clin Med 2021 ; 3:1137 – 47 . 27 Sakr Y et al . Randomized controlled multicentre study of albumin replacement therapy in septic shock ( ARISS ): protocol for a randomized controlled trial . Trials 2020:21:1002 . 28 Albumin ( Human ) 5 % Solution . ALBURX 5 . Prescribing information . 29 Albumin ( Human ) 25 % Solution . ALBURX 25 . Prescribing information .
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