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

  1. Roberto de la Rica
  2. Marcio Borges
  3. Maria Aranda
  4. Alberto del Castillo
  5. Antonia Socias
  6. Antoni Payeras
  7. Gemma Rialp
  8. Lorenzo Socias
  9. Lluis Masmiquel
  10. Marta Gonzalez-Freire

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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.

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  1. Version published to 10.3390/microorganisms8081106
  2. Version published to 10.1101/2020.05.07.20094987v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.05.07.20094987: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent.
    Consent: Written informed consent was waived due to the rapid emergence of this infectious disease.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed using version 3.5.2 of the R programming language (R Project for Statistical Computing; R Foundation).
    R Project for Statistical
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations of the study: This study has several limitations. First, the study population is small and only includes patients from Son Llatzer hospital, one of the main hospitals within Balearic Health system. There may be a selection bias when identifying factors that differ between non-ICU and ICU patients, even though the results were adjusted for known confounders, including age, sex, race, SpO2, smoking status and comorbidities. Also, this study is the first to show the characteristics of severe and critically ill COVID-19 adult patients in Spain. Secondly, this is a retrospective study done in an emergency situation. Third, the follow-up data could not be analyzed due to a delay in the update of the electronic health record database. Finally, some patients presented elevated biomarker data in some laboratory measures, and we did not exclude them from the analysis due to the small sample size and because those numbers were physiological and not due to technical error.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.05.07.20094987v1 on medRxiv