Prognostic Effect of Hypoalbuminaemia on Severity and Outcome in COVID-19: A Retrospective Cohort Study

Abstract

Introduction: Severe Acute Respiratory Disease Coronavirus-2 (SARS-CoV-2) is a novel virus first detected in December 2019 causing the Coronavirus Disease-2019 (COVID-19) which has evolved into a pandemic rapidly. In patients who become symptomatic, 5% require oxygen and 15% develop severe disease ranging from respiratory failure to sepsis and septic shock. Severe COVID-19 infection is associated with high mortality. Hypoalbuminaemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. Hypoalbuminaemia is found in patients with severe COVID-19 disease. Aim: To assess the prognostic value of hypoalbuminaemia on severity and mortality of patients with COVID-19 infection. Materials and Methods: The present retrospective cohort study analysed data of 200 consecutive patients, with confirmed diagnosis of COVID-19 admitted, discharged or diseased between the period of April 2021 to June 2021. They were further classified as severe and non severe, survivors and non survivors based on oxygen saturation levels as per World Health Organisation (WHO) criteria and based on survival status of the patients. Hypoalbuminaemia was defined as serum albumin <3.5 g/dL. Demographic characteristics, previous co-morbidities, clinical findings and laboratory findings were collected. Results: Hypoalbuminaemia was more frequent in patients with severe disease than in patients with non severe disease (28% vs 15%, chi square value 34.54, p<0.001), also hypoalbuminaemia was more frequent in non survivors than survivors (23.5% vs 19.5%. Chi-square value 43.794, p<0.001). A binary logistic regression analysis was performed to attribute the true association between hypoalbuminaemia and severity and survival status of the patients with 95% CI for OR and it was found statistically significant. Hence, hypoalbuminaemia was found to be an independent predictor of severity and mortality in the study subjects. Conclusion: Hypoalbuminaemia may serve as an independent prognostic marker and may be used to identify patients at risk of severity and death in COVID-19 patients.