Biomarkers · Liver & Nutritional
Serum Albumin
Higher values go with lower risk of death. In NHANES 1999–2018 with linked mortality to 2019, each standard deviation above average goes with 28% lower risk of death. We found the same pattern in NHANES
Serum Albumin and risk of death
Published curve higher than the NHANES fitNHANES fit higher
Risk of death relative to each curve's own reference value, so the two curves need not cross 1 at the same point. The dotted vertical line marks the NHANES median.
Serum Albumin by age and sex
Each bar runs from the 5th to the 95th percentile, the darker part from the 25th to the 75th, and the tick is the median. Not a reference range or a target.
The percentiles as a table
| Sex | Age | 5th | 25th | Median | 75th | 95th | n | Cycle / source |
|---|---|---|---|---|---|---|---|---|
| All | 20-39 | 3.60 | 4.00 | 4.20 | 4.40 | 4.70 | 1,431 | NHANES 2017-2018 |
| All | 40-59 | 3.60 | 3.90 | 4.10 | 4.30 | 4.50 | 1,548 | NHANES 2017-2018 |
| All | 60+ | 3.50 | 3.80 | 4.00 | 4.20 | 4.50 | 1,891 | NHANES 2017-2018 |
| All | all | 3.60 | 3.90 | 4.10 | 4.30 | 4.60 | 4,870 | NHANES 2017-2018 |
| Men | 20-39 | 3.80 | 4.10 | 4.30 | 4.50 | 4.80 | 684 | NHANES 2017-2018 |
| Men | 40-59 | 3.70 | 4.00 | 4.20 | 4.30 | 4.60 | 723 | NHANES 2017-2018 |
| Men | 60+ | 3.60 | 3.90 | 4.00 | 4.20 | 4.50 | 958 | NHANES 2017-2018 |
| Men | all | 3.60 | 4.00 | 4.20 | 4.40 | 4.70 | 2,365 | NHANES 2017-2018 |
| Women | 20-39 | 3.50 | 3.80 | 4.00 | 4.30 | 4.60 | 747 | NHANES 2017-2018 |
| Women | 40-59 | 3.40 | 3.80 | 4.00 | 4.20 | 4.50 | 825 | NHANES 2017-2018 |
| Women | 60+ | 3.50 | 3.80 | 4.00 | 4.20 | 4.40 | 933 | NHANES 2017-2018 |
| Women | all | 3.50 | 3.80 | 4.00 | 4.20 | 4.50 | 2,505 | NHANES 2017-2018 |
What studies found when this marker was changed
They describe what happened in those study groups, not a recommendation. See all catalogued interventions.
Measured changes in Serum Albumin, study by study
3 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| clinical | Fish-oil-based 3-in-1 parenteral nutrition infused during each haemodialysis session for 3 months in patients with protein-energy wasting unable to tolerate oral supplements | Serum albumin rose from 3.5 to 3.8 g/dL with IDPN vs 3.6 to 3.5 g/dL with dietary counselling at 3 months (P=0.01) | RCT | Kittiskulnam P, et al. Sci Rep. 2022. The beneficial effects of intradialytic… |
| diet | Oral protein-energy nutritional supplements in malnourished (dialysis) patients | Oral nutritional supplements raised serum albumin by 1.26 g/l (95% CI 0.50-2.02) vs control in dialysis patients (22 RCTs) | meta-analysis | Liu PJ, et al. Effects of oral nutritional supplements on the nutritional… |
| pharmacologic | Statin therapy for >3 months in adults on maintenance haemodialysis or peritoneal dialysis | Raises serum albumin by 1.70 g/L (95% CI 0.19 to 3.21) vs placebo in dialysis patients | meta-analysis | Sun L, et al. Ren Fail. 2015. Meta-analysis of statin therapy in maintenance… |
| pharmacologic | Statin therapy for >=4 weeks in people with nephrotic syndrome | Serum albumin 0.60 g/dL higher (95% CI 0.14-1.06) with statin vs no treatment in nephrotic syndrome | meta-analysis | Kong X, et al. Cochrane Database Syst Rev. 2013. Lipid-lowering agents for… |
Things that worsen it
| Type | Condition or exposure | Reported effect | Evidence | Source |
|---|---|---|---|---|
| behavioral | Severe systemic inflammation or protein-energy malnutrition | Inflammation and malnutrition both lower serum albumin by reducing synthesis; inflammation also raises catabolism (effect size not reported) | review | Don BR, et al. Serum albumin: relationship to inflammation and nutrition. Semin… |
| clinical | Nephrotic syndrome with heavy proteinuria (>3.5g/24hr) | Nephrotic syndrome presents with proteinuria and hypoalbuminemia (effect size not reported) | review | Abellada AMP. Renal and Urinary Conditions: Nephrotic Syndrome. FP Essent… |
| diet | Severe protein-energy wasting and cachexia (kidney disease) | Low serum albumin is a diagnostic criterion of protein-energy wasting (effect size not reported) | clinical guideline | Fouque D, et al. Kidney Int. 2008;73:391-398. |
What else moves this marker
They describe those study groups, not an individual, and an association is not a cause.
Diseases and conditions
| What | Effect on the marker | Comparison · population | Source |
|---|---|---|---|
| ↓ Persistent inflammation, immunosuppression and catabolism syndrome (PICS) · ICU survivors with PICS vs those without PICS, chronic critical illness or rapid recovery | -0.44 g/dL (95% CI -0.83 to -0.05) | PICS vs non-PICS intensive care survivors · Adult intensive care survivors (6 cohort studies, 22-391 patients each) | meta analysis · PMID 38688799 |
Sources
- Risk curve: Seidu 2020 (PMID 32378436): all-cause RR 0.66 (0.55-0.77) top vs bottom third of serum albumin (protective form). Scaled to US values (NHANES).
- Seidu et al. Serum albumin, cardiometabolic and other adverse outcomes: systematic review and meta-analyses of 48 published observational cohort studies involving 1,492,237 participants. Scandinavian cardiovascular journal : SCJ. 2020;54:280-293.
- Zhang et al. Associations of serum albumin and dietary protein intake with all-cause mortality in community-dwelling older adults at risk of sarcopenia. Heliyon. 2024;10:e29734.
- NHANES curve: our Cox model adjusted for age and sex, NHANES 1999–2018 with linked mortality to 2019.
Map Serum Albumin against another biomarker · Featured: Inflammation (CRP) × albumin · Red cell width (RDW) × albumin.
Related markers: Alanine Aminotransferase (ALT) · Albumin:Globulin Ratio (A/G) · Alkaline Phosphatase (ALP) · Aspartate Aminotransferase (AST) · De Ritis Ratio (AST/ALT) · FIB-4 Index (NAFLD Fibrosis Score) · Gamma-Glutamyl Transferase (GGT) · Serum Total Bilirubin