Role of serum albumin and proteinuria in patients with SARS-CoV-2 pneumonia
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Int J Clin Pract. 2021;75:e13946. wileyonlinelibrary.com/journal/ijcp | 1 of 5
© 2020 John Wiley & Sons Ltd
1 | INTRODUC TION
Hypoalbuminemia (<32 g/L) is amongst the most frequently observed
laboratory abnormalities in patients with SARS-CoV-2 infection1-4
and it was more pronounced in severe than mild-moderate cases.1,2
The underlying mechanism of hypoalbuminemia and its relationship
with respiratory failure and clinical outcome still needs to be clarified.
We retrospectively evaluated in our cohort of patients with
COVID-19 hospitalized at the Infectious Disease Ward (IDW) or intensive
care unit (ICU) of Fatebenefratelli-Sacco Hospital in Milan,
the prevalence of hypoalbuminemia and its association with the
severity of COVID-19, the levels of C-reactive protein, d-dimer and
interleukin-6 levels and the clinical outcome over a follow-up period
of 30 days.
Received: 18 May 2020 | Accepted: 14 December 2020
O R I G I N A L P A P E R
Role of serum albumin and proteinuria in patients with
Cinzia Bassoli1 | Letizia Oreni2 | Elisabetta Ballone3 | Antonella Foschi2 |
Andrea Perotti3 | Annalisa Mainini2 | Giacomo Casalini1 | Laura Galimberti2 |
Luca Meroni2 | Spinello Antinori1,2 | Laura Milazzo2
1Luigi Sacco Department of Biomedical and
Clinical Sciences, Università degli Studi di
Milano, Milan, Italy
2Department of Infectious Diseases, ASST
Fatebenefratelli Sacco, Milan, Italy
3Department of Anesthesiology and
Intensive Care, ASST Fatebenefratelli Sacco,
Luigi Sacco Hospital, Milan, Italy
Laura Milazzo, Department of Infectious
Diseases, ASST Fatebenefratelli Sacco,
Milan, Italy, Via GB Grassi 74, 20157, Milan,
Background: Hypoalbuminemia is frequently observed in patients with SARS-CoV-2
infection although its underlying mechanism and relationship with the clinical outcome
still need to be clarified.
Methods: We retrospectively evaluated in patients with COVID-19 hospitalised at
the Fatebenefratelli-Sacco Hospital in Milan, the prevalence of hypoalbuminemia,
its association with the severity of COVID-19, with the levels of C-reactive protein,
d-dimer and interleukin-6 and with clinical outcome over a follow-up period of
30 days. Urinalysis was evaluated in a subgroup of patients.
Results: Serum albumin levels <30 g/L were found in 105/207 (50.7%) patients at
hospital admission. Overall, the median albumin value was 29.5 g/L (IQR 25-32.8).
A negative association was found between albumin levels and severity of COVID-19
(P < .0001) and death (P = .003). An inverse correlation was observed between
albumin and both C-reactive protein and D-dimer at hospital admission (r = −.487 and
r = −.479, respectively; P < .0001). Finally, a positive correlation was found between
albumin levels and eGFR (r = .137; P = .049). Proteinuria was observed in 75% of patients
with available data and it did not differ between patients with hypoalbuminemia
and those with albumin ≥30 g/L (81% and 67%, respectively; P = .09).
Conclusion: In patients with COVID-19, hypoalbuminemia is common and observed
in quite an early stage of pulmonary disease. It is strictly associated with inflammation
markers and clinical outcome. The common finding of proteinuria, even in the
absence of creatinine increase, indicates protein loss as a possible biomarker of local
and systemic inflammation worthwhile to evaluate disease severity in COVID-19.