Abstract
BackgroundResearch surrounding COVID-19 (coronavirus disease 2019) is rapidly increasing, including the study of biomarkers for predicting outcomes. There is little data examining the correlation between serum albumin levels and COVID-19 disease severity. The purpose of this study is to evaluate whether admission albumin levels reliably predict outcomes in COVID-19 patients.MethodsWe retrospectively reviewed 181 patients from two hospitals who had COVID-19 pneumonia confirmed by polymerase chain reaction (PCR) testing and radiologic imaging, who were hospitalized between March and July 2020. We recorded demographics, COVID-19 testing techniques, and day of admission labs. The outcomes recorded included the following: venous thromboembolism (VTE), acute respiratory distress syndrome (ARDS), intensive care unit (ICU) admission, discharge with new or higher home oxygen supplementation, readmission within 90 days, in-hospital mortality, and total adverse events. A multivariate modified Poisson regression analysis was then performed to determine significant predictors for increased adverse events in patients with COVID-19 pneumonia.ResultsA total of 109 patients (60.2%) had hypoalbuminemia (albumin level < 3.3 g/dL). Patients with higher albumin levels on admission had a 72% decreased risk of developing venous thromboembolism (adjusted relative risk [RR]:0.28, 95% confidence interval [CI]:0.14–0.53, p<0.001) for every 1 g/dL increase of albumin. Moreover, higher albumin levels on admission were associated with a lower risk of developing ARDS (adjusted RR:0.73, 95% CI:0.55–0.98, p = 0.033), admission to the ICU (adjusted RR:0.64, 95% CI:0.45–0.93, p = 0.019), and were less likely to be readmitted within 90 days (adjusted RR:0.37, 95% CI:0.17–0.81, p = 0.012). Furthermore, higher albumin levels were associated with fewer total adverse events (adjusted RR:0.65, 95% CI:0.52–0.80, p<0.001).ConclusionsAdmission serum albumin levels appear to be a predictive biomarker for outcomes in COVID-19 patients. We found that higher albumin levels on admission were associated with significantly fewer adverse outcomes, including less VTE events, ARDS development, ICU admissions, and readmissions within 90 days. Screening patients may lead to early identification of patients at risk for developing in-hospital complications and improve optimization and preventative efforts in this cohort.
Highlights
Since the start of the pandemic, there have been incredible efforts to study coronavirus disease 2019 (COVID-19), including public health prevention [1], advancing diagnostic capabilities [2], treatment and vaccine development [3], and understanding the broad spectrum of disease sequelae [4]
Patients with higher albumin levels on admission had a 72% decreased risk of developing venous thromboembolism for every 1 g/dL increase of albumin
Higher albumin levels on admission were associated with a lower risk of developing acute respiratory distress syndrome (ARDS), admission to the intensive care unit (ICU), and were less likely to be readmitted within 90 days
Summary
Since the start of the pandemic, there have been incredible efforts to study coronavirus disease 2019 (COVID-19), including public health prevention [1], advancing diagnostic capabilities [2], treatment and vaccine development [3], and understanding the broad spectrum of disease sequelae [4]. Because of the broad variety of disease presentation, it is vital to determine predictors of worse outcomes for patients with COVID-19. This is of significant importance because the literature has shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect multiple organs and result in catastrophic events, such as myocardial infarction [8,9,10], pulmonary embolism [11], cerebral vascular accidents [12, 13], hepatic injury [14, 15], and mortality [16]. Several studies have identified biomarkers correlated with multiple organ failure and severe systemic disease in COVID-19 patients [17, 18]. The purpose of this study is to evaluate whether admission albumin levels reliably predict outcomes in COVID19 patients
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