ArticleAntimicrobial agents and chemotherapy2014
Impact of hypoalbuminemia on voriconazole pharmacokinetics in critically ill adult patients.
Article in Antimicrobial agents and chemotherapy, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 65 citations in OpenAlex.
- Factors affecting voriconazole pharmacokinetic variability in critically ill patients: a systematic review.Critical care (London, England) · 2025Pooled it
- Voriconazole therapeutic drug monitoring and safety in HIV-infected patients with invasive fungal disease.Frontiers in pharmacology · 2026Article
- Population Pharmacokinetics and Exposure-Response Analysis of Voriconazole in ICU and Non-ICU Hospitalized Adults.Infection and drug resistance · 2026Article
- Beyond Algorithms: Machine Learning and Clinical Determinants of Voriconazole Plasma Levels in Therapeutic Drug Monitoring.European journal of drug metabolism and pharmacokinetics · 2026Article
- Incorporating the metabolic ratio (C-Frontiers in pharmacology · 2026Article
- Factors associated with beyond-therapeutic serum voriconazole trough level among critically ill patients with invasive fungal infections.BMC infectious diseases · 2025Article
- What Is the Prognostic Significance of Culture-Documented Breakthrough Invasive Pulmonary Aspergillosis in Patients with Hematological Malignancies? A Propensity Score-Adjusted Analysis.Journal of fungi (Basel, Switzerland) · 2025Article
- Voriconazole in the treatment of pediatric patients with hematologic malignancies and invasive fungal infections: a real-world study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2025Article
- The Predictive Value of Initial Trough Concentration of Voriconazole and Procalcitonin in Hepatotoxic Adverse Events.Drug design, development and therapy · 2025Article
- Whole Body Physiologically Based Pharmacokinetic Model to Explain A Patient With Drug-Drug Interaction Between Voriconazole and Flucloxacillin.European journal of drug metabolism and pharmacokinetics · 2024Article
- Association of procalcitonin with voriconazole concentrations: a retrospective cohort study.BMC infectious diseases · 2024Article
- Influence of C-reactive protein on the pharmacokinetics of voriconazole in relation to theFrontiers in pharmacology · 2024Article
- Voriconazole Pharmacokinetics in Critically Ill Patients and Extracorporeal Membrane Oxygenation Support: A Retrospective Comparative Case-Control Study.Antibiotics (Basel, Switzerland) · 2023Article
- Pharmacokinetics of Voriconazole in Peritoneal Fluid of Critically Ill Patients.Antimicrobial agents and chemotherapy · 2023Article
- Hypoalbuminemia and Pharmacokinetics: When the Misunderstanding of a Fundamental Concept Leads to Repeated Errors over Decades.Antibiotics (Basel, Switzerland) · 2023Review
- Factors influencing plasma concentration of voriconazole and voriconazole- N-oxide in younger adult and elderly patients.Frontiers in pharmacology · 2023Article
- Site-Directed Spin Labeling EPR Spectroscopy for Determination of Albumin Structural Damage and Hypoalbuminemia in Critical COVID-19.Antioxidants (Basel, Switzerland) · 2022Article
- Clinical Features, Diagnostic Test Performance, and Prognosis in Different Subtypes of Chronic Pulmonary Aspergillosis.Frontiers in medicine · 2022Article
- Inflammation Affects Liver Function and the Metabolism of Voriconazole to Voriconazole-N-Oxide in Adult and Elderly Patients.Frontiers in pharmacology · 2022Article
- Recent Advances in Therapeutic Drug Monitoring of Voriconazole, Mycophenolic Acid, and Vancomycin: A Literature Review of Pediatric Studies.Pharmaceutics · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Setting the adequate dose for voriconazole is challenging due to its variable pharmacokinetics. We investigated the impact of hypoalbuminemia (<35 g/liter) on voriconazole pharmacokinetics in adult intensive care unit (ICU) patients treated with voriconazole (20 samples in 13 patients) as well as in plasma samples from ICU patients that had been spiked with voriconazole at concentrations of 1.5 mg/liter, 2.9 mg/liter, and 9.0 mg/liter (66 samples from 22 patients). Plasma albumin concentrations ranged from 13.8 to 38.7 g/liter. Total voriconazole concentrations in adult ICU patients treated with voriconazole ranged from 0.5 to 8.7 mg/liter. Unbound and bound voriconazole concentrations were separated using high-throughput equilibrium dialysis followed by liquid chromatography-tandem mass spectrometry (LC-MSMS). Multivariate analysis revealed a positive relationship between voriconazole plasma protein binding and plasma albumin concentrations (P < 0.001), indicating higher unbound voriconazole concentrations with decreasing albumin concentrations. The correlation is more pronounced in the presence of elevated bilirubin concentrations (P = 0.05). We therefore propose to adjust the measured total voriconazole concentrations in patients with abnormal plasma albumin and total serum bilirubin plasma concentrations who show adverse events potentially related to voriconazole via a formula that we developed. Assuming 50% protein binding on average and an upper limit of 5.5 mg/liter for total voriconazole concentrations, the upper limit for unbound voriconazole concentrations is 2.75 mg/liter. Alterations in voriconazole unbound concentrations caused by hypoalbuminemia and/or elevated bilirubin plasma concentrations cannot be countered immediately, due to the adult saturated hepatic metabolism. Consequently, increased unbound voriconazole concentrations can possibly cause adverse events, even when total voriconazole concentrations are within the reference range.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.