Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases

Abstract

Coronavirus disease 2019 (COVID-19) is a global pandemic which has caused numerous deaths worldwide. The present study investigated the roles of hypoproteinemia in the clinical outcome and liver dysfunction of COVID-19 patients. In this retrospective study, we extracted data from 2,623 clinically confirmed adult COVID-19 patients (≥18 years old) between January 29, 2020 and March 6, 2020 in Tongji Hospital, Wuhan, China. The patients were divided into three groups-non-critically ill, critically ill, and death groups-in accordance with the Chinese Clinical Guideline for COVID-19. Serum albumin, low-density lipoproteins cholesterol (LDL-C), and high-density lipoproteins cholesterol (HDL-C) concentrations and inflammatory cytokines levels were measured and compared among these three groups. The median age of these 2,623 patients was 64 years old (interquartile range (IQR), 52-71). Among the patients enrolled in the study, 2,008 (76.6%) were diagnosed as non-critically ill and 615 (23.4%) were critically ill patients, including 383 (14.6%) critically ill survivors and 232 (8.8%) critically ill deaths in the hospital. Marked hypoalbuminemia occurred in 38.2%, 71.2%, and 82.4% patients in non-critically ill, critically ill, and death groups, respectively, on admission and 45.9%, 77.7%, and 95.6% of these three groups, respectively, during hospitalization. We also discovered that serum low-density lipoprotein (LDL) and HDL levels were significantly lower in critically ill and death groups compared to non-critically ill group. Meanwhile, the patients displayed dramatically elevated levels of serum inflammatory factors, while a markedly prolonged activated partial thromboplastin time (APTT) in critically ill patients reflected coagulopathy. This study suggests that COVID-19-induced cytokine storm causes hepatotoxicity and subsequently critical hypoalbuminemia, which are associated with exacerbation of disease-associated inflammatory responses and progression of the disease and ultimately leads to death for some critically ill patients.

Declined serum high density lipoprotein cholesterol is associated with the severity of COVID-19 infection

“…Currently, COVID-19 infection-associated dyslipidemia had been reported in several clinical studies [6] , [7] , [12] , however, underlying mechanism of cholesterol metabolism in COVID-19 infection is still unknow. Hitherto, the most widely investigation of virus infection with dyslipidemia is HIV-associated dyslipidemia [13] , [14] .…”

Preventing Mortality in COVID-19 Patients: Which Cytokine to Target in a Raging Storm?

“…Chief among them are age, sex, and comorbidities such as hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, and obesity ( Chen T. et al, 2020 ; Cummings et al, 2020 ; Hajifathalian et al, 2020 ; Shi et al, 2020 ; Simonnet et al, 2020 ; Tian W. et al, 2020 ; Wu et al, 2020 ; Zhou F. et al, 2020 ). Immune parameters that are closely linked to COVID-19 mortality, established by analysis of large numbers of deceased patients, include elevated levels of IL-6, D-dimer, c-reactive protein (CRP), serum ferritin, and lactate dehydrogenase (LDH), as well as decreased lymphocyte counts and hypoalbuminemia ( Cummings et al, 2020 ; Huang J. et al, 2020 ; Huang W. et al, 2020 ; Ruan et al, 2020 ; Tian W. et al, 2020 ; Wu et al, 2020 ; Yan et al, 2020 ; Zhou F. et al, 2020 ). These parameters are clearly indicative of systemic hyperinflammation and immune dysfunction in moribund COVID-19 patients.…”

Beneficial effects exerted by hydroxychloroquine in treating COVID-19 patients via protecting multiple organs

“…The liver performs vital functions such as playing a central role in metabolism, detoxification, and protein synthesis. Albumin is one of the most abundant serum proteins and is synthesized by hepatocytes; serum albumin levels are significantly reduced in COVID-19 patients (Liu C., et al, 2020;Huang et al, 2020;Liu W. et al, 2020). In our study patients, HCQ administration led to an elevation in serum albumin levels to their normal range in both the critically and non-critically ill patients ( Figure 1C and D).…”

“…More than 3.5 million infections and 246,838 deaths have occurred as of May 4, 2020 (Saqrane and El Mhammedi, 2020), with a rapid upward trend. Many COVID-19 patients suffer from complicated systemic injuries such as cardiac (Chen et al, 2020) and hepatic (Huang et al, 2020) damages. There are currently no specific drugs on the market to treat COVID-19-induced systemic injuries (Ni et al, 2020).…”