Hypoalbuminemia and clinical outcomes: What is the mechanism behind the relationship?

Sunghye Kim, Stephen A. McClave, Robert Martindale, Keith R. Miller, Ryan T. Hurt

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Albumin has a number of important physiologic functions, which include maintaining oncotic pressure, transporting various agents (fatty acids, bile acids, cholesterol, metal ions, and drugs), scavenging free oxygen radicals, acting as an antioxidant, and exerting an antiplatelet effect. Hypoalbuminemia in adults, defined by an intravascular albumin level of <3.5 g/dL, is associated with poor postoperative outcomes in patients undergoing surgical intervention. Although the relationship of hypoalbuminemia and poor surgical outcome has been known for many years, the pathophysiology behind the relationship is unclear. Three theoretical constructs might explain this relationship. First, albumin might serve as a nutritional marker, such that hypoalbuminemia represents poor nutritional status in patients who go on to experience poor postoperative outcomes. Second, albumin has its own pharmacologic characteristics as an antioxidant or transporter, and therefore, the lack of albumin might result in a deficiency of those functions, resulting in poor postoperative outcomes. Or third, albumin is known to be a negative acute phase protein, and as such hypoalbuminemia might represent an increased inflammatory status of the patient, potentially leading to poor outcomes. A thorough review of the literature reveals the fallacy of these arguments and fails to show a direct cause and effect between low albumin levels per se and adverse outcomes. Interventions designed solely to correct preoperative hypoalbuminemia, in particular intravenous albumin infusion, do little to change the patient's course of hospitalization. While surgeons may use albumin levels on admission for their prognostic value, they should avoid therapeutic strategies whose main endpoint is correction of this abnormality.

Original languageEnglish (US)
Pages (from-to)1220-1227
Number of pages8
JournalAmerican Surgeon
Volume83
Issue number11
StatePublished - Nov 1 2017

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Hypoalbuminemia
Albumins
Antioxidants
Acute-Phase Proteins
Nutritional Status
Bile Acids and Salts
Intravenous Infusions
Free Radicals
Reactive Oxygen Species
Hospitalization
Fatty Acids
Metals
Cholesterol
Ions
Pressure

ASJC Scopus subject areas

  • Surgery

Cite this

Kim, S., McClave, S. A., Martindale, R., Miller, K. R., & Hurt, R. T. (2017). Hypoalbuminemia and clinical outcomes: What is the mechanism behind the relationship? American Surgeon, 83(11), 1220-1227.

Hypoalbuminemia and clinical outcomes : What is the mechanism behind the relationship? / Kim, Sunghye; McClave, Stephen A.; Martindale, Robert; Miller, Keith R.; Hurt, Ryan T.

In: American Surgeon, Vol. 83, No. 11, 01.11.2017, p. 1220-1227.

Research output: Contribution to journalArticle

Kim, S, McClave, SA, Martindale, R, Miller, KR & Hurt, RT 2017, 'Hypoalbuminemia and clinical outcomes: What is the mechanism behind the relationship?', American Surgeon, vol. 83, no. 11, pp. 1220-1227.
Kim, Sunghye ; McClave, Stephen A. ; Martindale, Robert ; Miller, Keith R. ; Hurt, Ryan T. / Hypoalbuminemia and clinical outcomes : What is the mechanism behind the relationship?. In: American Surgeon. 2017 ; Vol. 83, No. 11. pp. 1220-1227.
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