What is the significance of serum albumin levels?

From the Guidelines

Serum albumin levels are a critical indicator of patient outcomes, with higher levels associated with lower risks of technique failure and death, and should be monitored regularly to guide clinical management. Serum albumin is a vital protein in the blood, making up about 60% of total plasma protein, and serves multiple essential functions, including maintaining fluid balance, transporting substances, buffering blood pH, and acting as an antioxidant 1. Low serum albumin levels, or hypoalbuminemia, can indicate malnutrition, liver disease, kidney disease, inflammation, or protein-losing conditions, and are often associated with poorer outcomes in various diseases 1.

Key Points

• Normal serum albumin levels typically range from 3.5 to 5.0 g/dL, with values below 3.5 g/dL considered hypoalbuminemia 1
• Serum albumin concentration should be monitored on a regular basis, with a stable or rising value being desirable, and measured at least every 4 months 1
• The highest albumin level possible should be the goal for each patient, and can be obtained by adequate nutrition, prevention and treatment of catabolic illness, and maintenance of Kt/Vurea and creatinine 1
• Albumin infusions may be used in specific situations, such as severe hypovolemia or certain types of edema, but its broader use as a resuscitation agent is not well defined 1

Clinical Implications

• Clinically, albumin levels are important prognostic indicators in many diseases, with low levels often associated with poorer outcomes 1
• Treatment of hypoalbuminemia should focus on addressing the underlying cause rather than simply replacing albumin 1
• Recent studies have shown that targeting a specific level of albumin may be associated with higher rates of pulmonary edema and fluid overload, highlighting the need for careful consideration of albumin therapy 1

From the Research

Significance of Serum Albumin Levels

• Serum albumin is a critical plasma protein with various clinical indications, including management of circulatory and renal dysfunction in patients with ascites 2
• It has multiple physiologic functions, such as immunomodulation, endothelial stabilization, antioxidant effects, and binding multiple drugs, toxins, and other molecules 2, 3
• Serum albumin levels are a significant prognostic marker in various disease settings, including liver and malabsorption syndromes, cardiovascular diseases, COVID-19 infection, nephrology, oncology, and autoimmune rheumatic diseases 3, 4

Clinical Implications

• Hypoalbuminemia is a powerful prognostic marker for long-term survival in several clinical settings and a strong biomarker for poor prognosis in most diseases 3
• Serum albumin is independently associated with the development of various deleterious conditions, such as coronary artery disease, heart failure, atrial fibrillation, and stroke 4
• Low serum albumin levels are associated with worse recovery following acute pathologies and increased risk of post-surgery complications, especially infections 5

Prognostic Value

• Serum albumin levels have prognostic value in patients with end-stage renal disease (ESRD), with hypoalbuminemia being a major risk factor for morbidity and mortality 6
• Albumin is a good marker of nutritional status in clinically stable people, and significant loss of muscle mass has been observed in elderly people with low albumin levels 5
• Hypoalbuminemia is a mortality prognostic factor in elderly people, whether they live in the community or are in hospital or institutionalized 5