Serum Albumin Levels: Who Needs Them?

Area of Science:

• Critical Care Medicine
• Clinical Chemistry

Background:

• Serum albumin levels are frequently monitored in intensive care units (ICUs).
• Hypoalbuminemia (low serum albumin) is common in critically ill patients and associated with adverse outcomes.
• Albumin is an acute phase reactant, leading to fluctuating levels that correlate with illness severity.

Purpose of the Study:

• To review indications for ordering serum albumin levels in adult critically ill patients.
• To evaluate the supporting literature for these indications.
• To provide recommendations for appropriate serum albumin testing.

Main Methods:

• A critical narrative review was conducted.
• Searches included PubMed (1966-2020), Cochrane Library, and clinical practice guidelines.
• Bibliographies of retrieved articles were also searched.

Main Results:

• Common indications for ordering serum albumin include guiding albumin administration, estimating free drug levels (phenytoin, calcium), nutritional monitoring, and illness severity assessment.
• However, routine ordering of serum albumin levels is often not supported by robust evidence.
• Inappropriate testing can lead to unnecessary interventions and increased healthcare costs.

Conclusions:

• Except for use in specific severity-of-illness scoring systems, there is limited evidence to justify routine serum albumin level testing in critically ill patients.
• Clinicians should exercise caution when ordering serum albumin levels to avoid unnecessary treatments and costs.