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. 2020 Jun 18;63(11):1678–1687. doi: 10.1007/s11427-020-1733-4

Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases

Wei Huang 1,2,#, Chenze Li 1,#, Zhiquan Wang 2, Hong Wang 1, Ning Zhou 1, Jiangang Jiang 1, Li Ni 1, Xin A Zhang 3, Dao-Wen Wang 1,✉
PMCID: PMC7306450  PMID: 32567003

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.

Electronic Supplementary Material

Supplementary material is available for this article at 10.1007/s11427-020-1733-4 and is accessible for authorized users.

Keywords: albumin, hepatic injury, COVID-19

Electronic supplementary material

11427_2020_1733_MOESM1_ESM.pdf (87.5KB, pdf)

Table S1 Plasma inflammatory cytokine levels.

Acknowledgements

This work was supported in part by the National Natural Science Foundation of China (81790624, 81630010, and 81800261).

Compliance and ethics The author(s) declare that they have no conflict of interest.

Footnotes

Contributed equally to this work

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Associated Data

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Supplementary Materials

11427_2020_1733_MOESM1_ESM.pdf (87.5KB, pdf)

Table S1 Plasma inflammatory cytokine levels.

Articles from Science China. Life Sciences are provided here courtesy of Nature Publishing Group

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