Human albumin as adjuvant treatment for sepsis and septic shock: myth and reality

Abstract

Albumin is a multifunctional protein which plays a major role in physiology, drugs pharmacokinetics, and detoxication, partly due to its ligand specificity and its ability to bind a large number of endogenous and exogenous substances. Albumin is the main determinant of oncotic pressure and is therefore used for volume expansion in hypovolemia, shock, burns, liver failure or chronic liver disease, and denutrition. If albumin appears to be safe as far as hemodynamic effects, renal function and survival are concerned, its benefice as fluid expander in septic shock is controversial and experimental as well as clinical data are contradictory. Compared to other plasma expanders, it is a blood-derived and expensive product. Albumin would finally have antioxidative properties and modulate inflammation, thus decreasing capillary permeability. Human albumin is indeed involved in the inflammatory and oxidative stress pathways modulation and may thus be beneficial in septic shock, through improvement of endothelial dysfunction. Albumin is also less pro-inflammatory than other plasma expanders, decreasing neutrophils activation and infiltration. It would even exhibit immunosuppressive effects. All these properties seem to be dose-dependent.

In severe sepsis, albumin could be useful for fluid resuscitation and as an antioxidative or anti-inflammatory adjuvant therapy. Albumin use for volume expansion is controversial, as experimental and clinical data diverge. Albumin is more expansive and at risk of blood pathogens transmission compared to cristalloids and other colloids. This review provides an update on albumin characteristics and properties and albumin indication in the treatment of sepsis and septic shock.