[The determination of total protein is not a suitable diagnosis for the treatment of hypoalbuminemia in intensive care patients].

In clinical practice, the administration of supplementary albumin often depends on the measured plasma concentration of total protein (TPC). A TPC of less than 5 g/dl is generally accepted as an indication for albumin therapy, assuming an albumin concentration of less than 2.5 g/dl. However, a physiological relation between TPC and albumin cannot be expected in critically ill patients, and thus, measurement of TPC may be misleading as an indicator for the use of albumin. Therefore, we investigated the sensitivity and specificity of TPC testing for diagnosing hypoalbuminaemia requiring treatment. METHODS. In this prospective study, 210 consecutive patients were included. Protein electrophoresis was performed three times a week; the second electrophoresis was selected for evaluation. Applied statistical analysis revealed the number of positive total protein tests indicating hypoalbuminaemia requiring treatment (sensitivity) and the number of negative with tolerable reduced albumin concentrations (specificity). RESULTS. Of the investigated patients, 27.6% had normal TPCs between 6.2 and 8.0 g/dl. In 81.9% of cases an albumin concentration below 3.5 g/dl was found, while 43 patients had a concentration below 2.5 g/dl. The sensitivity and specificity of TPC measurement for the diagnosis of clinically relevant hypoalbuminaemia (albumin concentration < 2.5 g/dl) was calculated at different cutoff points for total protein. With a TPC of 6.0 g/dl, the sensitivity was 0.96 and the specificity 0.44. With a cutoff point of 5.0 g/dl, the sensitivity was reduced to 0.65 and specificity increased to 0.86. Finally, with a TPC of 4.0 g/dl sensitivity was 0.25 and specificity almost 1. CONCLUSIONS. Depending on the cutoff point for TPC, a relevant albumin requirement would frequently not be detected. In other cases, a need for albumin would be assumed from a reduced TPC even though the albumin concentration still exceeded 2.5 g/dl. Therefore, determination of TPC is not a suitable indicator of the need for albumin replacement. As a result, we suggest routine determination of albumin concentrations instead of TPC.