Department of Medicine, Trios Health- A University of Washington Medicine Community Health Partner, Kennewick, Washington, United States of America.
Department of Cardiology, Lourdes Medical Center, Pasco, Washington, United States of America.
PLoS One. 2021 Mar 16;16(3):e0248358. doi: 10.1371/journal.pone.0248358. eCollection 2021.
Research 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.
We 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.
A 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).
Admission 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.
围绕 COVID-19（冠状病毒病 2019）的研究正在迅速增加，包括预测结果的生物标志物研究。几乎没有数据可以检查血清白蛋白水平与 COVID-19 疾病严重程度之间的相关性。本研究的目的是评估入院时白蛋白水平是否可靠地预测 COVID-19 患者的结局。
我们回顾性分析了 2020 年 3 月至 7 月间在两家医院因聚合酶链反应（PCR）检测和影像学证实患有 COVID-19 肺炎的 181 例患者。我们记录了人口统计学、COVID-19 检测技术和入院时的实验室检查。记录的结果包括以下内容：静脉血栓栓塞（VTE）、急性呼吸窘迫综合征（ARDS）、重症监护病房（ICU）入院、出院时需要新的或更高的家庭氧疗、90 天内再次入院、住院期间死亡率和总不良事件。然后进行多变量修正泊松回归分析，以确定 COVID-19 肺炎患者发生不良事件增加的显著预测因素。
共有 109 例患者（60.2%）存在低白蛋白血症（白蛋白水平<3.3 g/dL）。入院时白蛋白水平较高的患者发生静脉血栓栓塞的风险降低 72%（调整后的相对风险[RR]：0.28，95%置信区间[CI]：0.14-0.53，p<0.001），每增加 1 g/dL 白蛋白。此外，入院时较高的白蛋白水平与发生 ARDS 的风险降低相关（调整后的 RR：0.73，95% CI：0.55-0.98，p=0.033）、入住 ICU（调整后的 RR：0.64，95% CI：0.45-0.93，p=0.019）的风险降低以及 90 天内再次入院的风险降低（调整后的 RR：0.37，95% CI：0.17-0.81，p=0.012）。此外，较高的白蛋白水平与总不良事件减少相关（调整后的 RR：0.65，95% CI：0.52-0.80，p<0.001）。
入院时血清白蛋白水平似乎是 COVID-19 患者结局的预测生物标志物。我们发现，入院时较高的白蛋白水平与显著较少的不良结局相关，包括较少的 VTE 事件、ARDS 发生、ICU 入院和 90 天内再次入院。对患者进行筛查可能会导致早期发现有发生院内并发症风险的患者，并改善该队列的优化和预防措施。
