From the Guidelines
Low albumin is a significant finding that warrants medical attention, as it is associated with a higher risk of postoperative intra-abdominal sepsis and may indicate underlying health issues such as malnutrition, inflammation, or liver disease. When albumin levels fall below the normal range, it often indicates an underlying health issue. Low albumin (hypoalbuminemia) can result from various conditions, including liver disease, kidney problems, malnutrition, inflammation, or protein-losing conditions. This finding is clinically important because albumin maintains oncotic pressure in blood vessels, transports hormones and medications, and serves as a marker of nutritional status and overall health. Patients with low albumin may experience edema (swelling), delayed wound healing, and increased susceptibility to infections.
Key Points to Consider
- According to the British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults 1, hypoalbuminemia (albumin <30 g/L) is frequently associated with severe malnutrition and is a reflection of significant inflammation or secondary to malabsorption.
- The evidence to support the use of intravenous albumin is weak, and correction of hypoalbuminemia hinges on treatment of underlying sepsis and control of inflammation 1.
- Treatment focuses on addressing the underlying cause rather than simply supplementing albumin. For instance, liver disease may require hepatoprotective medications, while malnutrition would necessitate nutritional support with adequate protein intake.
- Healthcare providers should investigate low albumin promptly with additional tests like liver function panels, kidney function tests, and nutritional assessments to determine the specific cause and appropriate treatment plan.
Recommendations for Management
- Monitor serum albumin concentration regularly, as a stable or rising value is desirable 1.
- Evaluate serum albumin levels in the context of the patient’s overall clinical status, including comorbid diseases, peritoneal transport type, delivered dose of PD, and quality-of-life issues 1.
- Aim for the highest albumin level possible for each patient, which can be obtained by adequate nutrition, prevention and treatment of catabolic illness, and maintenance of Kt/Vurea and creatinine 1.
From the Research
Significance of Low Albumin
Low albumin is a significant finding that has been associated with various adverse outcomes in different patient populations. Some of the key points related to low albumin include:
- Low serum albumin is a common finding in patients with chronic heart failure (HF) and is associated with increased mortality and cardiac-related hospitalizations 2
- Hypoalbuminemia is also prevalent in patients admitted to internal medicine wards and is associated with poor prognosis, including increased mortality and morbidity 3
- In patients with advanced liver diseases, low albumin levels are associated with poor outcomes, but administration of human albumin solutions may be beneficial in certain situations 4
- Low albumin levels on admission are associated with increased short- and long-term mortality in hospitalized patients, and normalization of albumin levels before discharge is associated with better survival 5
- Hypoalbuminemia is also associated with alterations in lipid metabolism, including increased serum cholesteryl ester transfer protein concentration in children with idiopathic nephrotic syndrome 6
Clinical Implications
The clinical implications of low albumin are significant, and include:
- Increased risk of mortality and morbidity in patients with chronic heart failure, internal medicine ward admissions, and advanced liver diseases
- Association with poor prognosis and increased risk of complications in hospitalized patients
- Potential benefits of albumin supplementation in certain patient populations, such as those with advanced liver diseases
- Importance of monitoring and managing albumin levels in patients with nephrotic syndrome and other conditions associated with hypoalbuminemia
Key Findings
Some of the key findings related to low albumin include:
- Low serum albumin is a significant predictor of reduced survival in patients with chronic heart failure 2
- Hypoalbuminemia on admission and on discharge is associated with poor prognosis in patients admitted to internal medicine wards 3
- Administration of human albumin solutions may be beneficial in patients with advanced liver diseases, but requires careful consideration of the risks and benefits 4
- Low albumin levels on admission are associated with increased short- and long-term mortality in hospitalized patients 5
- Hypoalbuminemia is associated with alterations in lipid metabolism in children with idiopathic nephrotic syndrome 6