Impact of Early Administration of Albumin on Mortality Among Severe COVID-19 Patients, China

Jing Sha,1 Guiqing Kong,2 Lin Fu,3 Peng Wang,4 Lin Zhang,1 Tao Wang,2 Fangqiang Song,5 Yufeng Chu,4 Mei Meng6 1Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, People’s Republic of China; 2Department of Intensive Care Unit, Binzhou Medical University Hospital, Binzhou, Shandong, People’s Republic of China; 3Department of Critical Care Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China; 4Neurocritical Care Unit, Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong, People’s Republic of China; 5Department of Critical Care Medicine, Tengzhou Central People’s Hospital, Tengzhou, Shandong, People’s Republic of China; 6Department of Critical Care Medicine, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, People’s Republic of ChinaCorrespondence: Yufeng Chu, Email [email protected] Mei Meng, Email [email protected]: Hypoalbuminemia is commonly observed in patients with severe Coronavirus Disease 2019 (COVID-19) and is independently associated with adverse outcomes. However, the efficacy of albumin administration on the clinical prognosis of these patients remains uncertain.Patients and Methods: This multicenter retrospective study enrolled 458 patients with severe COVID-19 in four medical centers from December 1, 2022, to June 1, 2024. Clinical features and laboratory variables were collected through electronic medical records. The cohorts were divided into two groups: albumin administration and non-albumin administration. Propensity score matching (PSM) was used for minimizing confounding effect. Statistical analyses were conducted to assess the relationship between early albumin administration and 28-day mortality.Results: Four hundred and fifty-eight severe COVID-19 cases were included in the study, of which 167 (36.5%) received early albumin administration, while 291 (63.5%) did not. Among these patients, 140 experienced in-hospital mortality and 318 survived. Compared to survivors, non-survivors exhibited significantly lower serum albumin levels (29.1g/L vs.33.8g/L, p < 0.05). In comparison to patients with admission albumin levels ≥ 30 g/L, those with albumin levels < 30 g/L had a significantly higher in-hospital mortality (48.4% vs 21.1%, p < 0.001). Prior to PSM, the albumin administration group demonstrated significantly higher 28-day and in-hospital cumulative survival rates compared to the non-albumin group (both p < 0.001). However, no significant differences were observed between the two groups following PSM (p = 0.21 and p = 0.41, respectively).Conclusion: Hypoalbuminemia was correlated with adverse outcomes in severe COVID-19 patients. However, early albumin administration did not reduce 28-day mortality and in-hospital mortality in these patients, and more relative RCTs were required for validation.Keywords: COVID-19, SARS-CoV-2, hypoalbuminemia, albumin, administrations, mortality