Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice

Abstract

Serum albumin (ALB), one of the most important proteins in human physiology, has the main functions of maintaining plasma oncotic pressure and plasma volume, transporting hormones, vitamins, oligominerals and drugs, and exerting a powerful antioxidant-anti-inflammatory role. Its prognostic value in liver and malabsorption syndromes is well known. In this narrative review, an analysis of the most important studies evaluating the prognostic significance of low serum ALB levels in hospitalized patients was performed. Specifically, the risk in emergency medicine, cardiovascular diseases, Coronavirus Disease 19 (COVID-19) infection, nephrology, oncology, and autoimmune rheumatic diseases has been examined to fully explore its clinical value. ALB is a negative acute-phase reactant and the reduction in its serum levels represents a threatening parameter for long-term survival in several clinical settings, and a strong biomarker for a poor prognosis in most diseases. Therefore, clinicians should consider serum ALB as a valuable tool to assess the efficacy of specific therapies, both in hospitalized patients and in chronic follow-up.

Keywords: albumin levels; autoimmune diseases; cardiology; emergency department; infectious diseases; intensive care units; nephrology; oncology; pre-albumin levels; rheumatology.

Figure 1

Anti-oxidant properties of Albumin. MET: methionine; ROS: reactive oxygen species; PUFA: Polyunsaturated fatty acids; Cys34: cysteine34; Modified from “The antioxidant properties of serum albumin” [20]. doi: 10.1016/j.febslet.2008.04.057. Epub 2008 May 12. PMID: 18474236.

Figure 2

Key substances transported by albumin. NO: nitric oxide. Modified from “The antioxidant properties of serum albumin” [20]. doi: 10.1016/j.febslet.2008.04.057. Epub 2008 May 12. PMID: 18474236.