From the Guidelines
Albumin administration is not routinely recommended in the management of acute pancreatitis unless patients have severe hypoalbuminemia or evidence of significant third-spacing with hemodynamic instability. The primary management of pancreatitis should focus on aggressive fluid resuscitation with crystalloids and nutritional support. According to the ESPEN guidelines on parenteral nutrition for the pancreas 1, the indication for nutritional support in acute pancreatitis is actual or anticipated inadequate oral intake for 5–7 days. Key considerations in the management of pancreatitis include:
- Assessment of the severity of acute pancreatitis and the patient’s nutritional status
- Decision making for artificial nutrition based on the severity and nutritional status
- Avoidance of overfeeding when parenteral nutrition is administered
- Consideration of parenteral glutamine supplementation when parenteral nutrition is indicated The use of intravenous lipids as part of parenteral nutrition is safe and feasible when hypertriglyceridemia is avoided, as stated in the ESPEN guidelines 1. In cases where albumin is considered necessary, infusion at 1-1.5 g/kg/day divided into multiple doses may be appropriate, taking into account the patient's hemodynamic status and serum albumin levels. Monitoring of serum albumin levels, along with other markers of severity, should guide fluid management decisions in acute pancreatitis.
From the Research
Albumin Levels in Pancreatitis
- Albumin levels have been studied as a potential indicator of prognosis in patients with acute pancreatitis 2, 3.
- A study published in 2013 found that albumin variation within 24 hours of ICU admission was associated with death in patients with severe acute pancreatitis 2.
- Another study published in 2017 found that serum albumin was a good indicator of persistent organ failure in acute pancreatitis, with lower albumin levels upon admission being associated with a higher risk of persistent organ failure 3.
Treatment with Fresh Frozen Plasma
- Fresh frozen plasma (FFP) has been proposed as a potential therapy for acute pancreatitis, as it may replenish important circulating proteins such as albumin 4, 5.
- A study published in 1983 found that treatment with FFP was associated with a low mortality rate in patients with acute pancreatitis, although the study did not specifically examine the role of albumin 4.
- A later study published in 1991 found that FFP therapy increased the concentrations of certain proteins, including albumin, but did not improve clinical outcome in patients with severe acute pancreatitis 5.
Prognostic Value of Albumin
- The prognostic value of albumin in acute pancreatitis has been studied, with some studies suggesting that low albumin levels are associated with a higher risk of poor outcomes 2, 3.
- A study published in 2017 found that serum albumin was an independent prognostic factor for persistent organ failure in acute pancreatitis, with an area under the ROC curve of 0.873 3.
- The use of albumin as a prognostic indicator may be useful in identifying patients at high risk of poor outcomes, although further study is needed to fully understand its role in acute pancreatitis 2, 3.