Abstract
ABSTRACT.Most critically ill patients experience malnutrition, resulting in a poor prognosis. This study aimed to evaluate the association of prealbumin (PAB) with the prognosis for severely and critically ill coronavirus disease 2019 (COVID-19) patients and explore factors related to this association. Patients with laboratory-confirmed COVID-19 from West Campus of Union Hospital in Wuhan from January 29, 2020 to March 31, 2020 were enrolled in this study. Patients were classified into the PAB1 (150–400 mg/L; N = 183) and PAB2 (< 150 mg/L; N = 225) groups. Data collection was performed using the hospital’s electronic medical records system. The predictive value of PAB was evaluated by measuring the area under the receiver-operating characteristic (AUROC) curve. Patients were defined as severely or critically ill based on the Guidance for COVID-19 (7th edition) by the National Health Commission of China. During this analysis, 316 patients had severe cases and 65 had critical cases. A reduced PAB level was associated with a higher risk of mortality and a longer hospital stay. The AUROC curve for the prognosis based on the PAB level was 0.93, with sensitivity of 97.2% and specificity of 77.6%. For severe cases, a lower level of PAB was associated with a higher risk of malnutrition, higher NK cell counts, and lower B lymphocyte counts; these factors were not significant in critical cases. C-reactive protein and nutritional status mediated the association between PAB and prognosis. This retrospective analysis suggests that the PAB level on admission is an indicator of the prognosis for COVID-19.
Highlights
During early December 2019, several cases of pneumonia of unknown etiology were reported in Wuhan, Hubei Province, China.[1,2] Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen of coronavirus disease 2019 (COVID-19).[2,3] COVID-19 is a highly infectious and contagious disease that quickly spread to more than 55 countries worldwide within 3 months.[4]
Ill patients were defined using the following criteria: respiratory failure requiring a form of mechanical ventilation; shock; and complications associated with other organ failure that require monitoring and treatment in the intensive care unit (ICU)
The PAB level has been identified as a better indicator of the prognosis for COVID-19.12,33 A metaanalysis including 19 studies and 4616 COVID-19 patients suggested that severely ill patients and nonsurvivors had lower PAB levels, which were significantly associated with COVID-19 severity and mortality.[21]
Summary
During early December 2019, several cases of pneumonia of unknown etiology were reported in Wuhan, Hubei Province, China.[1,2] Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen of coronavirus disease 2019 (COVID-19).[2,3] COVID-19 is a highly infectious and contagious disease that quickly spread to more than 55 countries worldwide within 3 months.[4] As of January 24, 2021, the cumulative number of reported cases was more than 98.2 million and there were more than 2.1 million deaths globally since the start of the pandemic.[5] approximately 15% to 20% of COVID-19 cases progressed to severe cases.[6] Notably, severely and critically ill patients usually developed acute respiratory distress syndrome (ARDS) or organ failure,[7] leading to higher mortality.[6,8] During an early study, approximately 17% of patients developed ARDS and 11% of patients had worsened conditions during a short period of time and died of multiple organ failure.[2]
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