Steroids Can Cause Hypoalbuminemia
Yes, steroids can cause hypoalbuminemia, particularly when administered at high doses for prolonged periods (above 20 mg prednisolone daily or equivalent for more than 6 weeks). 1
Mechanism of Steroid-Induced Hypoalbuminemia
- Corticosteroids increase net loss of protein in both children and adults with Crohn's disease, contributing to hypoalbuminemia 1
- Steroids drive catabolism and cause anorexia and nausea, which can worsen nutritional status and further reduce albumin levels 1
- The inflammatory burden from underlying conditions being treated with steroids can independently reduce serum albumin concentrations 1
Clinical Significance
- Hypoalbuminemia is a valid marker of protein-energy nutritional status in patients with chronic conditions 2
- Hypoalbuminemia is a surgical risk factor and is associated with higher risk of postoperative complications 2, 3
- Low albumin levels (<30 g/L) are associated with higher risk of postoperative intra-abdominal sepsis in inflammatory bowel disease patients 2
- Perioperative hypoalbuminemia is linked to increased wound complications, hospitalization costs, and length of stay 3
Pharmacokinetic Implications
- Hypoalbuminemia affects drug binding and pharmacokinetics, as albumin is the main drug transporter in blood 4, 5
- There is a significant correlation between the extent of plasma protein binding of prednisolone and serum albumin concentration 5
- In patients with liver disease and low albumin, higher levels of unbound (active) prednisolone circulate in the blood 5
- This altered binding can lead to increased drug activity and potential toxicity, requiring dose adjustments 4
Monitoring and Management
- Regular assessment of serum albumin levels is necessary when patients are on long-term steroid therapy 2
- The primary approach to steroid-induced hypoalbuminemia is treating the underlying cause rather than the low albumin level itself 2
- Providing adequate nutritional support is especially important in patients on steroids who develop hypoalbuminemia 2
- Albumin infusion is generally not recommended for treating hypoalbuminemia unless specific conditions are present (e.g., spontaneous bacterial peritonitis, large-volume paracentesis in cirrhosis) 2, 6
Prevention Strategies
- Use steroids for the shortest time possible with downward titration of the dose whenever feasible 1
- Monitor for nutritional status in patients requiring long-term steroid therapy 1
- Consider nutritional support in patients at risk of malnutrition while on steroid therapy 2
- Be aware that steroid-induced hypoalbuminemia may be exacerbated in patients with active inflammatory conditions 1
Special Considerations
- In patients with liver disease, the conversion of prednisone to prednisolone may be impaired, and lower serum albumin concentrations are associated with higher levels of unbound prednisolone 5
- Malnutrition can further aggravate steroid-induced hypoalbuminemia 7
- Patients with inflammatory bowel disease on steroids are particularly susceptible to hypoalbuminemia due to the combined effects of inflammation, malnutrition, and steroid-induced catabolism 1