Low Albumin Levels Are Associated with Poorer Outcomes in a Case Series of COVID-19 Patients in Spain: A Retrospective Cohort Study

Abstract

There is limited information available describing the clinical and epidemiological features of Spanish patients requiring hospitalization for coronavirus disease 2019 (COVID-19). In this observational study, we aimed to describe the clinical characteristics and epidemiological features of severe (non-ICU) and critically patients (ICU) with COVID-19 at triage, prior to hospitalization. Forty-eight patients (27 non-ICU and 21 ICU) with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were analyzed (mean age, 66 years, [range, 33–88 years]; 67% males). There were no differences in age or sex among groups. Initial symptoms included fever (100%), coughing (85%), dyspnea (76%), diarrhea (42%) and asthenia (21%). ICU patients had a higher prevalence of dyspnea compared to non-ICU patients (95% vs. 61%, p = 0.022). ICU-patients had lymphopenia as well as hypoalbuminemia. Lactate dehydrogenase (LDH), C-reactive protein (CRP), and procalcitonin were significantly higher in ICU patients compared to non-ICU (p < 0.001). Lower albumin levels were associated with poor prognosis measured as longer hospital length (r = −0.472, p < 0.001) and mortality (r = −0.424, p = 0.003). As of 28 April 2020, 10 patients (8 ICU and 2 non-ICU) have died (21% mortality), and while 100% of the non-ICU patients have been discharged, 33% of the ICU patients still remained hospitalized (5 in ICU and 2 had been transferred to ward). Critically ill patients with COVID-19 present lymphopenia, hypoalbuminemia and high levels of inflammation.

Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis

“…Three studies were prospective [ 29 , 41 , 52 ], 51 retrospective [ 20 – 28 , 30 – 34 , 36 – 39 , 42 – 46 , 48 – 51 , 53 , 54 , 57 – 60 , 62 , 63 , 65 , 66 , 69 – 76 , 78 , 80 , 81 , 83 – 86 ], while 13 did not specifically declare the study design [ 23 , 35 , 40 , 47 , 55 , 56 , 61 , 64 , 67 , 68 , 77 , 79 , 82 ]. Fifty-two studies (77.6%) were performed in China [ 22 , 24 – 26 , 28 – 31 , 33 – 35 , 37 – 43 , 46 – 57 , 59 , 62 – 64 , 68 – 85 ] while the remaining 15 were conducted in the rest of the world [ 20 , 21 , 23 , 27 , 32 , 36 , 44 , 45 , 58 , 60 , 61 ...…”

Red Blood Cell Distribution Width, Disease Severity, and Mortality in Hospitalized Patients with SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis

“…After a full-text review of the remaining 12 articles, one further study was excluded because of missing information. Thus, 11 studies were included in the meta-analysis [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. Their characteristics are presented in Table 1 .…”

“…A total of 4901 COVID-19 patients were studied, 4247 (50% males, mean age 52 years) with low severity or who survived and 654 (57% males, mean age 66 years) with high severity or who died. Two studies were prospective [ 34 , 36 ], while the remaining nine were retrospective [ 30 , 31 , 32 , 33 , 35 , 37 , 38 , 39 , 40 ]. Six studies were performed in Asia [ 30 , 33 , 35 , 38 , 39 , 40 ], three in Europe [ 32 , 36 , 37 ], and two in America [ 31 , 34 ].…”

“…Two studies were prospective [ 34 , 36 ], while the remaining nine were retrospective [ 30 , 31 , 32 , 33 , 35 , 37 , 38 , 39 , 40 ]. Six studies were performed in Asia [ 30 , 33 , 35 , 38 , 39 , 40 ], three in Europe [ 32 , 36 , 37 ], and two in America [ 31 , 34 ]. End points included disease severity based on current clinical guidelines in six studies [ 30 , 33 , 34 , 35 , 39 , 40 ], survival in three [ 31 , 36 , 37 ], and transfer to ICU in two [ 32 , 38 ].…”

“…In 10 of these studies, patients with severe disease or non-survivor status displayed higher RDW values when compared to those with mild disease or survivor status (mean difference range, 0.13 to 2.01) [ 30 , 31 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 ]. However, the difference was not statistically significant in four studies [ 32 , 35 , 37 , 40 ]. In the remaining study, the RDW values were mildly, non-significantly, higher in patients with mild disease or survivor status (mean difference, −0.06) [ 36 ].…”