What does a high albumin (protein) level indicate?

What Does High Albumin Level Indicate?

High albumin levels most commonly indicate dehydration (hemoconcentration of plasma proteins), rather than a specific disease process. 1

Understanding Albumin

• Albumin is a protein produced exclusively by the liver that serves multiple biological functions including maintenance of oncotic pressure, binding and transport of substances (fatty acids, bilirubin, thyroid hormone, drugs), metabolism of compounds, and antioxidant properties 2
• Normal serum albumin range is approximately 3.5-5.0 g/dL, though laboratory-specific ranges may vary 1
• While low albumin is commonly observed in clinical practice, elevated albumin levels are relatively uncommon 1

Main Causes of Elevated Albumin

• Dehydration: The most common cause of elevated albumin is hemoconcentration due to dehydration 1
• Resolution of inflammatory conditions: As albumin is a negative acute-phase reactant, levels increase following recovery from inflammation 1
• Increased protein or energy intake: Albumin levels may rise modestly with increased nutritional intake 2, 1

Clinical Significance and Evaluation

• Assess hydration status as the first step when encountering elevated albumin 1
• Review recent dietary changes, particularly high protein intake 1
• Consider whether the patient is recovering from a recent inflammatory condition 2, 1

Important Considerations

• Serum albumin should be interpreted in the context of the patient's overall clinical status 2
• Serial monitoring of albumin is more informative than a single measurement 2, 1
• Laboratory method variations can affect albumin results, so reference ranges should be laboratory-specific 2, 1

What Albumin Does NOT Indicate

• Unlike low albumin, which is strongly associated with increased mortality risk, high albumin is generally not associated with adverse outcomes 3
• In fact, patients with hyperalbuminemia on admission and before discharge have been shown to have the best short- and long-term survival compared to those with normal or low albumin levels 3

Common Pitfalls

• Overinterpreting albumin levels as a marker of nutritional status without considering other factors 2, 4
• Failing to recognize that albumin levels are affected by multiple factors beyond nutrition, including inflammation and hydration status 2
• Not considering the functional quality of albumin (effective vs. total albumin) when interpreting results 5

Management Approach

• Ensure adequate hydration if dehydration is suspected 1
• If albumin remains elevated despite adequate hydration, consider further evaluation for other causes 1
• No specific treatment is typically needed for isolated elevated albumin levels 1