tetano
Editor, Senior Moderator
Sci China Life Sci
. 2020 Jun 18.
doi: 10.1007/s11427-020-1733-4. Online ahead of print.
Decreased Serum Albumin Level Indicates Poor Prognosis of COVID-19 Patients: Hepatic Injury Analysis From 2,623 Hospitalized Cases
Wei Huang[SUP] 1 2 [/SUP], Chenze Li[SUP] 1 [/SUP], Zhiquan Wang[SUP] 2 [/SUP], Hong Wang[SUP] 1 [/SUP], Ning Zhou[SUP] 1 [/SUP], Jiangang Jiang[SUP] 1 [/SUP], Li Ni[SUP] 1 [/SUP], Xin A Zhang[SUP] 3 [/SUP], Dao-Wen Wang[SUP] 4 [/SUP]
Affiliations
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic which has caused numerous deaths worldwide. The present study investigated the roles of hypoproteinemia in the clinical outcome and liver dysfunction of COVID-19 patients. In this retrospective study, we extracted data from 2,623 clinically confirmed adult COVID-19 patients (>18 years old) between January 29, 2020 and March 6, 2020 in Tongji Hospital, Wuhan, China. The patients were divided into three groups-non-critically ill, critically ill, and death groups-in accordance with the Chinese Clinical Guideline for COVID-19. Serum albumin, low-density lipoproteins cholesterol (LDL-C), and high-density lipoproteins cholesterol (HDL-C) concentrations and inflammatory cytokines levels were measured and compared among these three groups. The median age of these 2,623 patients was 64 years old (interquartile range (IQR), 52-71). Among the patients enrolled in the study, 2,008 (76.6%) were diagnosed as non-critically ill and 615 (23.4%) were critically ill patients, including 383 (14.6%) critically ill survivors and 232 (8.8%) critically ill deaths in the hospital. Marked hypoalbuminemia occurred in 38.2%, 71.2%, and 82.4% patients in non-critically ill, critically ill, and death groups, respectively, on admission and 45.9%, 77.7%, and 95.6% of these three groups, respectively, during hospitalization. We also discovered that serum low-density lipoprotein (LDL) and HDL levels were significantly lower in critically ill and death groups compared to non-critically ill group. Meanwhile, the patients displayed dramatically elevated levels of serum inflammatory factors, while a markedly prolonged activated partial thromboplastin time (APTT) in critically ill patients reflected coagulopathy. This study suggests that COVID-19-induced cytokine storm causes hepatotoxicity and subsequently critical hypoalbuminemia, which are associated with exacerbation of disease-associated inflammatory responses and progression of the disease and ultimately leads to death for some critically ill patients.
Keywords: COVID-19; albumin; hepatic injury.
. 2020 Jun 18.
doi: 10.1007/s11427-020-1733-4. Online ahead of print.
Decreased Serum Albumin Level Indicates Poor Prognosis of COVID-19 Patients: Hepatic Injury Analysis From 2,623 Hospitalized Cases
Wei Huang[SUP] 1 2 [/SUP], Chenze Li[SUP] 1 [/SUP], Zhiquan Wang[SUP] 2 [/SUP], Hong Wang[SUP] 1 [/SUP], Ning Zhou[SUP] 1 [/SUP], Jiangang Jiang[SUP] 1 [/SUP], Li Ni[SUP] 1 [/SUP], Xin A Zhang[SUP] 3 [/SUP], Dao-Wen Wang[SUP] 4 [/SUP]
Affiliations
- PMID: 32567003
- DOI: 10.1007/s11427-020-1733-4
Abstract
Coronavirus disease 2019 (COVID-19) is a global pandemic which has caused numerous deaths worldwide. The present study investigated the roles of hypoproteinemia in the clinical outcome and liver dysfunction of COVID-19 patients. In this retrospective study, we extracted data from 2,623 clinically confirmed adult COVID-19 patients (>18 years old) between January 29, 2020 and March 6, 2020 in Tongji Hospital, Wuhan, China. The patients were divided into three groups-non-critically ill, critically ill, and death groups-in accordance with the Chinese Clinical Guideline for COVID-19. Serum albumin, low-density lipoproteins cholesterol (LDL-C), and high-density lipoproteins cholesterol (HDL-C) concentrations and inflammatory cytokines levels were measured and compared among these three groups. The median age of these 2,623 patients was 64 years old (interquartile range (IQR), 52-71). Among the patients enrolled in the study, 2,008 (76.6%) were diagnosed as non-critically ill and 615 (23.4%) were critically ill patients, including 383 (14.6%) critically ill survivors and 232 (8.8%) critically ill deaths in the hospital. Marked hypoalbuminemia occurred in 38.2%, 71.2%, and 82.4% patients in non-critically ill, critically ill, and death groups, respectively, on admission and 45.9%, 77.7%, and 95.6% of these three groups, respectively, during hospitalization. We also discovered that serum low-density lipoprotein (LDL) and HDL levels were significantly lower in critically ill and death groups compared to non-critically ill group. Meanwhile, the patients displayed dramatically elevated levels of serum inflammatory factors, while a markedly prolonged activated partial thromboplastin time (APTT) in critically ill patients reflected coagulopathy. This study suggests that COVID-19-induced cytokine storm causes hepatotoxicity and subsequently critical hypoalbuminemia, which are associated with exacerbation of disease-associated inflammatory responses and progression of the disease and ultimately leads to death for some critically ill patients.
Keywords: COVID-19; albumin; hepatic injury.