Ischemia-modified albumin and the IMA/albumin ratio in the diagnosis and staging of hemorrhagic shock: A randomized controlled experimental study

Ulus Travma Acil Cerrahi Derg. 2020 Mar;26(2):153-162. doi: 10.14744/tjtes.2019.32754.


Background: To determine the value of ischemia-modified albumin (IMA) and IMA/albumin ratio (IMAR) in the diagnosis and staging of hemorrhagic shock (HS).

Methods: A pressure-targeted HS model was established in this study. The control and shock groups were monitored for 30 min and 60 min to simulate varying durations of exposure to HS. All subjects underwent invasive arterial monitoring during the experiment and were further divided into mild and severe shock groups based on decreases in mean arterial pressure (MAP). Biochemical and histologic comparisons were performed between the groups.

Results: Our results revealed higher IMA, IMAR, lactate, total oxidant status (TOS) and oxidative stress index (OSI) levels in both the 30- and 60-min shock groups compared to the control group. Concerning MAP-based shock staging, IMA, IMAR, lactate, TOS and OSI levels in the 30-min and 60-min mild and severe shock groups were higher than those of the controls. However, there was no significant difference between the mild and severe shock groups. A significant correlation was determined between all the biomarkers evaluated and HS-induced damage in various organs. This correlation was highest in lactate and IMAR levels.

Conclusion: IMA and IMAR levels may be used in the early diagnosis of HS and also have the potential for use in determining the severity of HS. IMA and IMAR measurement may also be considered as an alternative or in addition to lactate measurement in the diagnosis of HS.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Biomarkers / blood
  • Blood Pressure / physiology
  • Female
  • Humans
  • Male
  • Serum Albumin / analysis*
  • Serum Albumin, Human
  • Shock, Hemorrhagic* / blood
  • Shock, Hemorrhagic* / classification
  • Shock, Hemorrhagic* / diagnosis


  • Biomarkers
  • Serum Albumin
  • ischemia-modified albumin
  • Serum Albumin, Human