Hypoalbuminemia - An Indicator of the Severity and Prognosis of COVID-19 Patients: A Multicentre Retrospective Analysis

Background: Hypoalbuminemia has been reported in COVID-19 patients. Exploring the influencing factors and possible adverse consequences of albumin reduction may provide some guidance for the treatment of COVID-19 patients. Methods: In this multicentre retrospective study, we collected information including demographics, comorbidities, clinical symptoms, complications, laboratory tests, treatment, and outcomes of patients diagnosed with COVID-19 from three hospitals in Wuhan, China. We compared the indexes between patients with hypoalbuminemia and normal albumin. Regression model was used to evaluate various influencing factors of patients with hypoalbuminemia and their relationship with clinical outcomes. We also compared the changes of particular laboratory indexes in patients with hypoalbuminemia before and after enteral nutrition therapy. Results: A total of 482 patients were enrolled in the study. About 53.7% patients developed hypoalbuminemia during admission. Patients with hypoalbuminemia were older, had a higher proportion of combined diabetes mellitus, fever, dyspnea, and natriuresis, and had a relatively poorer prognosis than patients with normal albumin. Patients with hypoalbuminemia had higher levels of CRP, leukocytes, ALT, AST, total bilirubin, ALP, GGT, LDH, creatine kinase, D-dimer, globulin, and lower levels of lymphocytes and eosinophils. Severe, older, anorexia, elevated CRP, and decreased lymphocytes were the independent predictors for decreased albumin in COVID-19 patients. In addition, decreased albumin is correlated with adverse outcomes. Nutritional support therapy to correct serum albumin may improve patient outcomes. Conclusion: COVID-19 patients with hypoalbuminemia tend to have more severe clinical manifestations and more abnormal biochemical tests, which may result in poorer clinical outcomes. Nutritional support therapy may improve the clinical outcome of these patients.