Albumin administration and acute phase proteins in abdominal vascular surgery. A randomised study

Abstract

Previous studies suggest that supplementary exogenous albumin may adversely affect hepatic protein synthesis. To test this, 18 patients undergoing elective abdominal aortic surgery were studied. Based on randomisation, nine patients received an average of 53.3 g albumin as part of blood replacement therapy, followed by 20 g albumin daily for the first three postoperative days. The remainder received no albumin. Sequential changes in plasma concentrations of albumin, transferrin, C-reactive protein, orosomucoid, fibrinogen and immunoglobulin G and A were monitored for the first week, as were changes in plasma volume and plasma colloid osmotic pressure. Supplementary albumin caused significant differences in plasma colloid osmotic pressure on postoperative days 1, 2 and 4 (p less than 0.01) and in albumin concentration at all postoperative measurement times (p less than 0.01). Plasma volumes did not differ between the groups. All protein fractions other than albumin showed identical curve sequences and peak concentrations. The significant decrease (p less than 0.01) in concentration of all proteins except albumin of the albumin group was quantitatively explained by unreplaced plasma loss. The study rules out consequences of clinical importance of albumin supplementation on hepatic protein synthesis.