Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection

Abstract

Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.

Individuals With Higher CD4/CD8 Ratio Exhibit Increased Risk of Acute Respiratory Distress Syndrome and In-Hospital Mortality During Acute SARS-CoV-2 Infection

“…A longitudinal cohort study where data of all consecutive patients admitted to the COVID-19 unit at Hospital del Mar, Barcelona, Spain for ≥48 h between March to May 2020 were collected. The study procedures have previously been described ( 3 , 14 ). As per protocol, the differentiation of CD4+ CD8+ T-cell subset was assessed in all admitted patients by flow cytometry at admission (day 1 of hospitalization), as well as a complete blood test.…”

“…Since its first detection in December of 2019, several prognosis factors have been described. Some of them are directly associated with uncontrolled immune response to the virus leading to a hyperinflammatory status, and some other ones such as hypoalbuminemia or myocardial injury, depend on the host clinical response ( 2 , 3 ). The impact of the virus in the immune system can be summarized as lymphopenia, which has been widely reported as a notable aspect of SARS-CoV-2 infection.…”

Correlation of Plasma Albumin Status with Markers of Hepato-biliary Dysfunction and Systemic Inflammation Among COVID-19 Patients

“…Several mechanisms have been adduced as the basis for the altered plasma albumin status frequently documented among the SARS-CoV-2 infected patients in the literature [5][6][7][8][9]. Some investigators have suggested the amplified systemic inflammatory events frequently inherent among those infected [6].…”

“…Previous studies have evaluated plasma albumin status among COVID-19 patients. However, most of these studies have been documented among the western populations and had included mostly patients with various comorbid conditions, gastrointestinal (GIT) features, and those on medications known to influence plasma albumin status [5][6][7][8][9].…”

Effects of Early Initiation of High-Dose Dexamethasone Therapy on Pro-Inflammatory Cytokines and Mortality in LPS-Challenged Mice

“…In clinical practice, weight loss is rarely observed in patients with sepsis because intensive fluid resuscitation is the mainstay treatment in order to maintain blood pressure [ 4 ]. However, according to previous studies, weight gain or edema accompanied by excessive fluid resuscitation or hypoalbuminemia in septic patients significantly increases sepsis-related mortality [ 21 , 22 ]. Future studies evaluating the therapeutic benefits of early, high-dose DEX therapy in patients with sepsis are warranted in order to confirm the clinical utility of early, high-dose glucocorticoid therapy for the management of sepsis.…”