Hypoalbuminemia – An Indicator of the Severity and Prognosis of COVID-19 Patients: A Multicentre Retrospective Analysis

Abstract

Background: Hypoalbuminemia has been reported in COVID-19 patients. Exploring the influencing factors and possible adverse consequences of albumin reduction may provide some guidance for the treatment of COVID-19 patients. Methods: In this multicentre retrospective study, we collected information including demographics, comorbidities, clinical symptoms, complications, laboratory tests, treatment, and outcomes of patients diagnosed with COVID-19 from three hospitals in Wuhan, China. We compared the indexes between patients with hypoalbuminemia and normal albumin. Regression model was used to evaluate various influencing factors of patients with hypoalbuminemia and their relationship with clinical outcomes. We also compared the changes of particular laboratory indexes in patients with hypoalbuminemia before and after enteral nutrition therapy. Results: A total of 482 patients were enrolled in the study. About 53.7% patients developed hypoalbuminemia during admission. Patients with hypoalbuminemia were older, had a higher proportion of combined diabetes mellitus, fever, dyspnea, and natriuresis, and had a relatively poorer prognosis than patients with normal albumin. Patients with hypoalbuminemia had higher levels of CRP, leukocytes, ALT, AST, total bilirubin, ALP, GGT, LDH, creatine kinase, D-dimer, globulin, and lower levels of lymphocytes and eosinophils. Severe, older, anorexia, elevated CRP, and decreased lymphocytes were the independent predictors for decreased albumin in COVID-19 patients. In addition, decreased albumin is correlated with adverse outcomes. Nutritional support therapy to correct serum albumin may improve patient outcomes. Conclusion: COVID-19 patients with hypoalbuminemia tend to have more severe clinical manifestations and more abnormal biochemical tests, which may result in poorer clinical outcomes. Nutritional support therapy may improve the clinical outcome of these patients.

Review: Roles of human serum albumin in prediction, diagnoses and treatment of COVID-19

“…Patients with concomitant hypoalbuminemia have higher mortality rates and longer hospital stays [31] . In a recent study on COVID-19 patients, hypoalbuminemia was found to be an independent risk factor for death, and the risk of death in patients with hypoalbuminemia was 6.394 times higher than that in patients with normal albumin [32] . Huang et al found that lower albumin levels on admission can predict the outcome of COVID-19 independent of other known indicators such as lymphocyte count or co-morbidities [33] .…”

Evaluation of a potential prognostic parameter for the inflammatory status in COVID‐19 patients: The inflammatory protein ratio

“…The progression to severe inflammatory status of patients with COVID-19 is problematic to monitor [25][26][27]. Several laboratory parameters have been considered to monitor the inflammatory status in COVID-19 patients, such as CRP, d-dimer, fibrinogen, and serum proteins [12,18,19].…”

“…Several laboratory parameters have been considered to monitor the inflammatory status in COVID‐19 patients, such as CRP, d ‐dimer, fibrinogen, and serum proteins [ 12 , 18 , 19 ].…”

“…Limited research has been done on simplifying the routine techniques for assessing the inflammatory status in COVID‐19 patients [ 17 ]. Based on this limitation, serum protein electrophoresis (SPE) has been considered for the inflammatory status assessment [ 18 , 19 ]. SPE is a fast laboratory technique that examines specific serum proteins into six main classes: albumin, α1‐, α2‐, β1‐, β2‐, and γ‐globulins.…”

COVID-19 and thrombosis: Clinical features, mechanism of disease, and therapeutic implications

“…In a preliminary study including a small group of COVID-19 patients, we found that albumin infusion at a dosage of 80 g/day for 3 days followed by 40 g/day in the following 4 days resulted in a significant reduction of D-dimer [30]. The mechanism accounting for low serum albumin in COVID-19 may be complex including not only its consumption as an anti-inflammatory molecule but also impaired liver synthesis, loss from concomitant renal disease, or impaired nutritional status [31,32]. Taken together, the data reported here suggest that these two variables, i.e.…”