You Would Be All Bummin' Without Albumin

Albumin is produced in the liver and is the most abundant protein in the blood, comprising ~60% of the total protein in circulation. It is a major carrier of hormones, enzymes, nutrients, and medications, and is instrumental in the maintenance of colloidal osmotic pressure (i.e., oncotic pressure) which prevents fluid from leaking out of blood vessels and into interstitial spaces.[1]

Assessing albumin levels can be complex as it will decrease with liver disease due to reduced synthesis, but can also decrease during infection, inflammation, burns, surgery, oxidative stress, ischemia, heart disease, stroke, fluid overload, advanced malnutrition, diabetes, and advanced kidney disease. A reduction in albumin will ultimately compromise its valuable antioxidant, anti-inflammatory, and anticoagulant effects.[2]

Albumin is considered a potent antioxidant and accounts for 70% of the free-radical trapping ability of serum. It is able to bind oxidative metal ions including copper, iron, nickel, vanadium, and cobalt. Excessive oxidative stress or ischemia can damage albumin and interfere with its vital functions. Ischemia-modified albumin (IMA) can be measured and is approved as an early diagnostic biomarker in myocardial infarction.[3]

Albumin may be protective in organophosphate pesticide poisoning as respiratory failure, hypotension, cardiac arrest, and renal replacement therapy were significantly lower in hospitalized patients with albumin levels above 4.5 g/dL.[4]

Albumin at the low end of the standard reference interval is associated with an increased risk of surgical complications[5] and increased mortality. Albumin above 4.5 g/dL was associated with the greatest short-term and long-term survival in hospitalized patients.[6]

Maintaining albumin levels above 4.5 g/dL is also associated with a reduction in all-cause mortality in healthy adults.[7] Albumin may appear falsely elevated in dehydration so hydration status must be taken into account during clinical assessment.

An optimal functional blood chemistry goal for albumin is 4.5-5.0 g/dL

The standard Reference Interval is 3.6-5.1 g/dL

Optimal Takeaways

Albumin is a vital protein:

• A carrier for nutrients, hormones, and medications
• A potent antioxidant
• Has anti-inflammatory and anti-coagulant effects
• Maintains oncotic pressure, helps stop fluid in blood vessels from leaking out into tissues
• Can be reduced during liver disease, inflammation, infection, surgery, oxidative stress, ischemia, heart disease, stroke, fluid overload, advanced malnutrition, diabetes, and advanced kidney disease
• Optimal levels are associated with a reduction in surgical complications, short-term and long-term survival in hospitalized patients, and reduced mortality in healthy adults

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References

[1] Pagana, Kathleen Deska; Pagana, Timothy J.; Pagana, Theresa N. Mosby's Diagnostic and Laboratory Test Reference. Elsevier Health Sciences. 2019

[2] Arques, Stephane. “Human serum albumin in cardiovascular diseases.” European journal of internal medicine vol. 52 (2018): 8-12. doi:10.1016/j.ejim.2018.04.014

[3] Sitar, Mustafa Erinç et al. “Human serum albumin and its relation with oxidative stress.” Clinical laboratory vol. 59,9-10 (2013): 945-52.

[4] Noh, Eul et al. “The clinical role of serum albumin in Organophospate poisoning.” Basic & clinical pharmacology & toxicology vol. 128,4 (2021): 605-614. doi:10.1111/bcpt.13546

[5] Bendersky, Victoria et al. “Determining the Optimal Quantitative Threshold for Preoperative Albumin Level Before Elective Colorectal Surgery.” Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract vol. 21,4 (2017): 692-699. doi:10.1007/s11605-017-3370-9

[6] Akirov, Amit et al. “Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients.” The American journal of medicine vol. 130,12 (2017): 1465.e11-1465.e19. doi:10.1016/j.amjmed.2017.07.020

[7] Fulks M, Stout RL, Dolan VF. Albumin and all‐cause mortality risk in insurance applicants. J Insur Med. 2010;42: 11–17.