ADMINISTRATION OF ALBUMIN TO PATIENTS WITH SEPSIS SYNDROME - A POSSIBLE BENEFICIAL ROLE IN PLASMA THIOL REPLETION

1. Albumin is often administered intravenously to critically ill patie nts as a volume expander, to combat hypoalbuminaemia, and to decrease hyperbilirubinaemia. There is, however, an ongoing debate concerning t he therapeutic benefit of the former which is an expensive form of tre atment. 2. Albumin has several biological :functions, in particular as a ligand binder. It also acts as an extracellular transition metal io n-binding and radical-scavenging antioxidant. These functions are infl uenced by the presence of an exposed thiol group (cys 34) on the surfa ce of the albumin molecule. 3. The ability of infused albumin to influ ence the plasmathiol pool, and hence antioxidant potential, was invest igated in patients with sepsis syndrome. 4. Plasma thiol levels rose r apidly after albumin infusion and remained elevated even after plasma albumin levels had declined significantly, due to interstitial leakage . Data are suggestive of some form of thiol exchange in the plasma of these patients between albumin and molecules containing oxidized thiol groups. 5. Administration of albumin to patients with sepsis syndrome leads to a sustained increase in plasma thiols. Thiols have several i mportant antioxidant functions, and thiol repletion in these patients, who are known to suffer from oxidative stress, may have beneficial an tioxidant effects. Antioxidant repletion may represent an important fa cet of clinically administered albumin.