The impact of hypoalbuminaemia severity on total teicoplanin concentrations after 3 days loading dose: a retrospective observational study

Purpose Hypoalbuminaemia is known to decrease total teicoplanin (TEIC) concentration; however, whether total TEIC concentration varies depending on hypoalbuminaemia severity remains unclear. This study investigated the correlation between the severity of hypoalbuminaemia and total TEIC concentrations. Methods A retrospective observational study was conducted on patients (≥ 18 years) administered TEIC between January 2017 and December 2024. Factors influencing total TEIC trough concentrations after 3 days loading dose (C_trough) were determined using multiple linear regression. Serum albumin levels were stratified into three groups. The total and predicted free TEIC C_trough of patients administered standard and high loading dose regimens were compared among the groups. Results The total TEIC C_trough was negatively correlated with age (p = 0.01) and positively correlated with serum albumin (p < 0.01) and TEIC loading dose for within 3 days (p < 0.01). The median total TEIC C_trough for the three groups were significantly different in both dosing regimens: standard, 9.9 [interquartile range, 9.2 − 12.1], 15.2 [12.5 − 17.8], and 17.1 [14.6 − 20.8] µg/mL; high, 13.5 [9.6 − 16.4], 17.6 [16.7 − 19.8], and 20.7 [17.4 − 23.6] µg/mL for albumin < 2.0 g/dL, 2.0 ≤ albumin < 3.0 g/dL, and albumin ≥ 3.0 g/dL, respectively. However, the predicted free TEIC C_trough was not significantly different among the albumin groups for either regimen. Conclusions The more severe the hypoalbuminaemia, the lower the total TEIC C_trough, but predicted free TEIC C_trough was not affected. Clinicians should consider lowering the target total TEIC concentrations in severe hypoalbuminaemia cases.