From the Guidelines
Hypoalbuminemia is characterized by edema, ascites, pleural effusions, pulmonary edema, skin changes, gastrointestinal symptoms, and laboratory findings of serum albumin levels below 3.5 g/dL, with severe hypoalbuminemia defined as levels below 2.5 g/dL, as noted in recent clinical guidelines 1.
Clinical Manifestations
The signs and symptoms of hypoalbuminemia include:
- Edema, particularly in dependent areas like the ankles, feet, and sacrum, which can progress to generalized edema (anasarca) in severe cases
- Ascites (fluid accumulation in the peritoneal cavity)
- Pleural effusions
- Pulmonary edema leading to shortness of breath
- Skin changes such as delayed wound healing, thinning, and increased fragility
- Gastrointestinal symptoms like anorexia, nausea, and malnutrition ### Laboratory Findings Laboratory findings typically show serum albumin levels below 3.5 g/dL, with severe hypoalbuminemia defined as levels below 2.5 g/dL, or even lower than 30 g/l in certain contexts, such as surgical patients, as indicated by the ESPEN working group 1.
Underlying Causes
Hypoalbuminemia can result from:
- Decreased production (liver disease, malnutrition)
- Increased loss (nephrotic syndrome, protein-losing enteropathy)
- Increased catabolism (inflammation, critical illness) ### Treatment and Management Treatment focuses on addressing the underlying cause while providing supportive care for symptoms, with the goal of improving morbidity, mortality, and quality of life outcomes, as emphasized in the context of nephrotic syndrome and its complications 2.
From the Research
Clinical Manifestations of Hypoalbuminemia
The signs and clinical manifestations of hypoalbuminemia can be diverse and are often associated with various underlying diseases. Some of the key clinical manifestations include:
- Edema, which can be highly invalidating, especially in elderly subjects 3
- Malnutrition and protein-calorie malnutrition 4
- Liver disease, such as cirrhosis 5
- Nephrotic syndrome and end-stage renal disease (ESRD) 6
- Heart failure, where hypoalbuminemia can facilitate the onset of cardiogenic pulmonary edema 7
- Sepsis and inflammation, which can lead to reduced albumin synthesis 6
Underlying Causes
The underlying causes of hypoalbuminemia can be categorized into several groups, including:
- Urinary albumin losses, as seen in nephrotic syndrome 6
- Insufficient increase in albumin synthesis to replace losses 6
- Inflammation and acute-phase response, leading to reduced albumin synthesis 6
- Malnutrition and inadequate nutrition 6, 4, 7
- Hemodilution, liver dysfunction, and protein-losing enteropathy 7
Prognostic Value
Hypoalbuminemia has been shown to have a strong predictive value on mortality and morbidity, regardless of its cause 5. It has also emerged as an independent predictor of incident heart failure in certain patient populations 7. The presence of hypoalbuminemia may have potential therapeutic consequences in clinical practice, including the need for targeted nutritional intervention and albumin administration 7.