Serum Albumin Levels as an Independent Predictor of Hospital Mortality in COVID-19 Pneumonia

Year 2025, Volume: 6 Issue: 2, 37 - 46, 31.05.2025

Gülçehre Oğuztürk , Ekrem Seyhan , Mehmet Atilla Uysal , Elif Yelda Niksarlıoğlu , Nurdan Şimşek Veske , Emine Şahin

https://doi.org/10.56766/ntms.1576486

Abstract

Background and aim: Coronavirus disease 2019 (COVID-19) is associated with a systemic inflammatory state responsible for disease progression. This study was conducted to researched the link between inflammatory markers and radiologic, clinical severity and hospital mortality in patients with COVID-19 pneumonia.
Methods: Cases diagnosed with COVID-19 pneumonia by SARS-CoV-2 polymerase chain reaction (RT-PCR) test and radiological imaging and hospitalized and treated were included in the study retrospectively. The connection between the clinical severity of the disease, its radiological extent, and inflammation markers [CRP, procalcitonin (PCT), Red cell distribution width, fibrinogen, ferritin, albumin, platelet- to lymphocyte ratio, neutrophil- to- lymphocyte ratio (NLR), and lymphocyte-to- monocyte ratio] and hospital mortality were investigated.
Results: 200 patients (mean age, 56.7 ± 16 years, 113 male) hospitalized with the diagnosis of COVID-19 pneumonia were included in the study. The median duration of hospital stay was eight days. The in-hospital mortality was 16. 5 %. Variables (p<0.1) included in the univariate analysis were age, pneumonia severity index (PSI), PCT, ferritin, albumin, CRP, Chest CT Severity Score (CT-SS), NLR, and lymphocyte count. Subsequent multivariate analysis suggested that albumin levels (p=0.018), CT-SS (p=0.015), and pneumonia severity index (PSI) (p=0.012) were independently related to hospital mortality.
Conclusion: Serum albumin levels can predict hospital mortality in patients with COVID-19 pneumonia.

Keywords

: inflammatory markers , hospital mortality , COVID-19 pneumonia

References

• 1. Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 22; 395(10224): 565-74.
• 2. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID- 19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8(4): 420-22.
• 3. Zumla A, Hui DS, Azhar EI, Memish ZA, Maeurer M. Reducing mortality from 2019-nCoV: host-directed therapies should be an option. Lancet 2020; 22(395): e35-e36.
• 4. Mehta P, McAuley DF, Brown M, et al. COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395(10229): 1033-34.
• 5. Zenga F, Huangc Y, Guoa Y, et al. Association of inflammatory markers with the severity of COVID-19: A meta-analysis. Int J Infect Dis 2020; 96: 467-74.
• 6. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol 2020; 92(7):791-96.
• 7. Richardson S, Hirsch JS, Narasimhan M, , et al. The Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020; 323(20):2052-59.
• 8. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-69.
• 9. Grasselli G, Greco M, Zanella A, Albano G, Antonelli M, Bellani G, et al. Risk Factors Associated with Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med 2020; 180(10):1345-55.
• 10. Quah P, Li A, Phua. Mortality rates of patients with COVID-19 in the intensive care unit: a systematic review of the emerging literature. Crit Care 2020; 24(1): 285.
• 11. Renaud B, Coma E, Labarere J, et al. Routine. Use of the Pneumonia Severity Index for Guiding the Site-of-Treatment Decision of Patients with Pneumonia in the Emergency Department: A Multicenter, Prospective, Observational, Controlled Cohort Study. Clin Infect Dis 2007; 44:41-49.
• 12. Fajgenbaum DC, June CH. Cytokine Storm. N Engl J Med. 2020; 383(23):2255-2273.
• 13. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 2020; 127: 104370. 14. Yang AP, Liu JP, Tao WQ, HM Li. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504. 15. Ji P, Zhu J, Zhong Z, Li H, Pang J, Li B, Zhang J.a. Association of elevated inflammatory markers and severe COVID-19. Medicine (Baltimore) 2020; 20; 99 (47): e23315.
• 16. Huang J, Cheng A, Kumar R, Fang Y, Chen G, Zhu Y, et al. Hypoalbuminemia predicts the outcome of COVID-19 independent of age and co-morbidity. J Med Virol 2020; 92 (10): 2152-2158.
• 17. Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y, et al. C-reactive protein correlates with CT findings and predicts severe COVID-19 early. J Med Virol 2020; 92(7):856-62.
• 18. E Poggiali, D Zaino, P Immovilli, Rovero L, Losi G, Dacrema A, et al. Lactate dehydrogenase and C-reactive protein as predictors of respiratory failure in COVID-19 patients. Clin Chim Acta 2020; 509: 135-38.
• 19. Han H, Ma Q, Li C, Rui R, Zhao L, Wang W. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerg Microbes Infect 2020; 9(1):1123-30
• 20. Haybar H, Pezeshki SMS, Saki N. Evaluation of complete blood count parameters in cardiovascular diseases: an early indicator of prognosis? Exp Mol Pathol 2019; 110:104267.
• 21. Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: a meta-analysis. Am J Emerg Med 2020; 38 (3): 641-47.
• 22. Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect 2020: 81(1):6-12.
• 23. Xia X, Wen M, Zhan S, H Jing, Chen W. An increased neutrophil/ lymphocyte ratio is an early warning signal of severe COVID-19. Nan Fang Yi Ke Da Xue Xue Bao 2020;40: 333-36.
• 24. Liu J, Li S, Liu J, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. E-Bio Medicine 2020; 55:102763.
• 25. Zeng F, Huang Y, Guo Y, et al. Association of inflammatory markers with the severity of COVID-19: A meta-analysis. International Journal of Infectious Diseases 2020; 96: 467–474.
• 26. G. Lippi, M. Plebani. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clin. Chim Acta 2020; 505: 190-91.
• 27. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2- 2 in Wuhan, China. Allergy 2020; 75(7): 1730-41.
• 28. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan. JAMA Intern Med 2020; 180 (7):934-43.
• 29. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020 28; 395(10229): 1054-62.
• 30. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr 2019; 43(2):181‐93.
• 31. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med 2020; 58(7):1131-34.
• 32. Muhammad A, Rawish F, Wade LS, Ragheb A. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care 2020; 26; 24(1):255. Paliogiannis P, Mangoni AA, Cangemi M, Fois AG, Carru C, Zinellu A. Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis. Clin Exp Med 2021; 28: 1-12.