ASSOCIATION BETWEEN ALBUMIN LEVELS AND OUTCOMES IN COVID-19: A RETROSPECTIVE COHORT STUDY
Main Article Content
Keywords
COVID-19, hypoalbuminemia, serum albumin, prognosis, mortality, ICU, lymphopenia, inflammation markers
Abstract
Background: The COVID-19 pandemic presents significant challenges to healthcare systems worldwide, necessitating a comprehensive understanding of factors influencing disease prognosis. Hypoalbuminemia, characterized by low serum albumin levels, has emerged as a noteworthy feature in severe COVID-19 cases and may have prognostic value.
Methodology: This retrospective cohort study analyzed data from 109 adult COVID-19 patients to investigate the relationship between hypoalbuminemia as a predictor of disease outcomes. Relevant clinical and laboratory data were collected, and statistical analyses were conducted to explore associations.
Results: Non-survivors were significantly older and more likely to be admitted to the ICU, presenting higher rates of comorbidities, lymphopenia, and abnormalities in various blood parameters. Hypoalbuminemia correlated with older age, increased ICU admissions, elevated mortality rates, higher neutrophil-to-lymphocyte ratios, and greater inflammation markers. Dyspnea was more frequent in the hypoalbuminemia group. These findings offer insights into identifying individuals at higher risk for adverse outcomes due to hypoalbuminemia in COVID-19.
Conclusion: Our study found a significant and independent relationship between low serum albumin levels at the initial presentation and the mortality risk in COVID-19 patients. These results indicate the importance of monitoring and addressing hypoalbuminemia as a possible prognostic marker in managing COVID-19. Early detection and intervention in patients with low albumin levels can contribute to better outcomes.
References
2. Alcaraz‐Quiles, J., Casulleras, M., Oettl, K., Titos, E., Flores‐Costa, R., Duran‐Güell, M., López‐Vicario, C., Pavesi, M., Stauber, R. E., and Arroyo, V. (2018). Oxidized albumin triggers a cytokine storm in leukocytes through p38 Mitogen‐Activated protein kinase: role in systemic inflammation in decompensated cirrhosis. Hepatology 68, 1937-1952.
3. Bennouar, S., Cherif, A. B., Kessira, A., Bennouar, D.-E., and Abdi, S. (2021). Development and validation of a laboratory risk score for the early prediction of COVID-19 severity and in-hospital mortality. Intensive and Critical Care Nursing 64, 103012.
4. Bernardi, M., Angeli, P., Claria, J., Moreau, R., Gines, P., Jalan, R., Caraceni, P., Fernandez, J., Gerbes, A. L., and O'Brien, A. J. (2020). Albumin in decompensated cirrhosis: new concepts and perspectives. Gut 69, 1127-1138.
5. Bezemer, G. F., and Garssen, J. (2021). TLR9 and COVID-19: a multidisciplinary theory of a multifaceted therapeutic target. Frontiers in Pharmacology 11, 601685.
6. Bihari, S., Bannard-Smith, J., and Bellomo, R. (2020). Albumin as a drug: its biological effects beyond volume expansion. Critical Care and Resuscitation 22, 257-265.
7. Bonilla-Palomas, J. L., Gámez-López, A. L., Moreno-Conde, M., López-Ibáñez, M. C., Anguita-Sánchez, M., de la Sacristana, Á. G., García-Catalán, F., and Villar-Ráez, A. (2014). Hypoalbuminemia in acute heart failure patients: causes and its impact on hospital and long-term mortality. Journal of cardiac failure 20, 350-358.
8. De Simone, G., di Masi, A., and Ascenzi, P. (2021). Serum albumin: a multifaced enzyme. International Journal of Molecular Sciences 22, 10086.
9. Fearon, K., Falconer, J. S., Slater, C., McMillan, D. C., Ross, J. A., and Preston, T. (1998). Albumin synthesis rates are not decreased in hypoalbuminemic cachectic cancer patients with an ongoing acute-phase protein response. Annals of surgery 227, 249.
10. Garibaldi, B. T., Fiksel, J., Muschelli, J., Robinson, M. L., Rouhizadeh, M., Perin, J., Schumock, G., Nagy, P., Gray, J. H., and Malapati, H. (2021). Patient trajectories among persons hospitalized for COVID-19: a cohort study. Annals of internal medicine 174, 33-41.
11. Gong, J., Ou, J., Qiu, X., Jie, Y., Chen, Y., Yuan, L., Cao, J., Tan, M., Xu, W., and Zheng, F. (2020). Multicenter development and validation of a novel risk nomogram for early prediction of severe 2019-novel coronavirus pneumonia.
12. Gremese, E., Bruno, D., Varriano, V., Perniola, S., Petricca, L., and Ferraccioli, G. (2023). Serum Albumin Levels: A Biomarker to Be Repurposed in Different Disease Settings in Clinical Practice. Journal of Clinical Medicine 12, 6017.
13. Huang, W., Li, C., Wang, Z., Wang, H., Zhou, N., Jiang, J., Ni, L., Zhang, X. A., and Wang, D.-W. (2020). Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases. Science China Life Sciences 63, 1678-1687.
14. Kragh-Hansen, U. (2016). Human serum albumin: a multifunctional protein. Albumin in medicine: pathological and clinical applications, 1-24.
15. Lai, C.-C., Shih, T.-P., Ko, W.-C., Tang, H.-J., and Hsueh, P.-R. (2020). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. International journal of antimicrobial agents 55, 105924.
16. Quinlan, G. J., Martin, G. S., and Evans, T. W. (2005). Albumin: biochemical properties and therapeutic potential. Hepatology 41, 1211-1219.
17. Rabbani, G., and Ahn, S. N. (2021). Roles of human serum albumin in prediction, diagnoses and treatment of COVID-19. International Journal of Biological Macromolecules 193, 948-955.
18. Ramadori, G. P. (2022). SARS-CoV-2-infection (COVID-19): clinical course, viral acute respiratory distress syndrome (ARDS) and cause (s) of death. Medical Sciences 10, 58.
19. Ramsay, E. S., and Lerman, M. A. (2015). How to use the erythrocyte sedimentation rate in paediatrics. Archives of Disease in Childhood-Education and Practice 100, 30-36.
20. Seebacher, V., Grimm, C., Reinthaller, A., Heinze, G., Tempfer, C., Hefler, L., and Polterauer, S. (2013). The value of serum albumin as a novel independent marker for prognosis in patients with endometrial cancer. European Journal of Obstetrics & Gynecology and Reproductive Biology 171, 101-106.
21. Signorini, C., Pignatti, P., and Coccini, T. (2021). How do inflammatory mediators, immune response and air pollution contribute to COVID-19 disease severity? A lesson to learn. Life 11, 182.
22. Sitar, M. E., Aydin, S., and Cakatay, U. (2013). Human serum albumin and its relation with oxidative stress. Clin Lab 59, 945-952.
23. Slutskiy, P., and Boonchutima, S. (2022). Credibility of the Official COVID Communication in Thailand: When People Stop Believing the Government. American Behavioral Scientist, 00027642221118297.
24. Soriani, M., Pietraforte, D., and Minetti, M. (1994). Antioxidant potential of anaerobic human plasma: role of serum albumin and thiols as scavengers of carbon radicals. Archives of biochemistry and biophysics 312, 180-188.
25. Vaid, A., Somani, S., Russak, A. J., De Freitas, J. K., Chaudhry, F. F., Paranjpe, I., Johnson, K. W., Lee, S. J., Miotto, R., and Richter, F. (2020). Machine learning to predict mortality and critical events in a cohort of patients with COVID-19 in New York City: model development and validation. Journal of medical Internet research 22, e24018.
26. Viana-Llamas, M. C., Arroyo-Espliguero, R., Silva-Obregón, J. A., Uribe-Heredia, G., Núñez-Gil, I., García-Magallón, B., Torán-Martínez, C. G., Castillo-Sandoval, A., Díaz-Caraballo, E., and Rodríguez-Guinea, I. (2021). Hypoalbuminemia on admission in COVID-19 infection: An early predictor of mortality and adverse events. A retrospective observational study. Medicina clinica 156, 428-436.
27. Wang, Y., Kang, H., Liu, X., and Tong, Z. (2020). Combination of RT‐qPCR testing and clinical features for diagnosis of COVID‐19 facilitates management of SARS‐CoV‐2 outbreak. Journal of medical virology 92, 538.
28. Wiedermann, C. J. (2021). Hypoalbuminemia as surrogate and culprit of infections. International Journal of Molecular Sciences 22, 4496.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Muhammad Asim Rana
Assistant Professor Amna Inayat Medical College, Consultant Physician Critical Care Medicine Bahria International Hospital, Lahore - Pakistan
Afzal Bhatti
Professor of Medicine, Head Department of Gastroenterology and Hepatology, Bahria International Hospital Lahore - Pakistan
Muhammad Sohail Khalid
Assistant Professor of Gastroenterology, Continental Medical College, Lahore - Pakistan
Ahmed Mohammed Hassan Mostafa
Specialist Medical Intensive Care Unit, Rashid Hospital, Dubai Health, Dubai - UAE
Ahmed M. Abdelbaky
Senior Specialist Medical Intensive Care Unit, Rashid Hospital, Dubai Health, Dubai - UAE
Mohamed Ibrahim Shoaib
Senior Specialist Medical Intensive Care Unit, Rashid Hospital, Dubai Health, Dubai - UAE
Wael Ghaly Elmasry
Senior Specialist Medical Intensive Care Unit, Rashid Hospital, Dubai Health, Dubai - UAE
Sitara Raza
Department of Critical Care Medicine, Bahria International Hospital, Lahore - Pakistan