Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 39758

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : OC28 - OC30 Full Version

Prognostic Effect of Hypoalbuminaemia on Severity and Outcome in COVID-19: A Retrospective Cohort Study


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52394.16366
Manasa AS Gowda, K Smruthi, R Vedavathi

1. Assistant Professor, Department of General Medicine, KIMS, Bengaluru, Karnataka, India. 2. Senior Resident, Department of General Medicine, KIMS, Bengaluru, Karnataka, India. 3. Professor, Department of General Medicine, KIMS, Bengaluru, Karnataka, India.

Correspondence Address :
Dr. Manasa AS Gowda,
House Number 2, Santhosh Vihar, Phase 1, 19th A Cross, Jakkur Main Road, Next to Renaissance Aero Apartment, Bengaluru, Karnataka, India.
E-mail: manasa.asg5@gmail.com

Abstract

Introduction: Severe Acute Respiratory Disease-Coronavirus-2 (SARS-CoV-2) is a novel virus first detected in December 2019 causing the Coronavirus Disease-2019 (COVID-19) which has evolved into a pandemic rapidly. In patients who become symptomatic, 5% require oxygen and 15% develop severe disease ranging from respiratory failure to sepsis and septic shock. Severe COVID-19 infection is associated with high mortality. Hypoalbuminaemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. Hypoalbuminaemia is found in patients with severe COVID-19 disease.

Aim: To assess the prognostic value of hypoalbuminaemia on severity and mortality of patients with COVID-19 infection.

Materials and Methods: The present retrospective cohort study analysed data of 200 consecutive patients, with confirmed diagnosis of COVID-19 admitted, discharged or diseased between the period of April 2021 to June 2021. They were further classified as severe and non severe, survivors and non survivors based on Oxygen Saturation (SpO2) levels as per World Health Organisation (WHO) criteria and based on survival status of the patients. Hypoalbuminaemia was defined as serum albumin <3.5 g/dL. Demographic characteristics, previous co-morbidities, clinical findings and laboratory findings were collected. Analytical variables were compared using the Chi-square test, level of significance was set at p-value <0.05.

Results: Hypoalbuminaemia was more frequent in patients with severe disease than in patients with non severe disease (28% vs 15%, Ch-square value was 34.54, p<0.001), also hypoalbuminaemia was more frequent in non survivors than survivors (23.5% vs 19.5%. Chi-square value was 43.794, p<0.001). A binary logistic regression analysis was performed to attribute the true association between hypoalbuminaemia and severity and survival status of the patients with 95% CI for OR and it was found statistically significant (p-value <0.001). Hence, hypoalbuminaemia was found to be an independent predictor of severity and mortality in the study subjects.

Conclusion: Hypoalbuminaemia may serve as an independent prognostic marker and may be used to identify patients at risk of severity and death in COVID-19 patients.

Keywords

Albumin, Coronavirus disease-2019, Marker, Mortality, Pandemic

Coronavirus Disease-2019 (COVID-19) is caused by SARS-CoV-2, a novel virus, first recognised in December 2019 in Wuhan, Hubei province, China. Out of the total people infected, some remain asymptomatic and among the symptomatic patients, 15% develop severe disease and 5% have critical disease with complications such as respiratory failure, Acute Respiratory Distress Syndrome (ARDS), sepsis and septic shock, thromboembolism and/or multiple organ failure, including acute kidney injury and cardiac injury (1). However there is currently no effective treatment for COVID-19 (2). Several unique characteristics have been found in severe COVID-19 such as lymphopenia, old age, high C-Reactive Protein (CRP) level and underlying co-morbid diseases significantly decreased albumin level (2).

Albumin, a small protein is synthesised by the liver, is a free oxygen radical scavenger, has antioxidant effects therefore, it plays a vital role in inflammation. Current literature supports the idea that clinical severity in patients with COVID-19 infection may be due to virally driven hyperinflammation as suggested by Huang J et al., (2). During critical illness, inflammatory mediators decrease albumin synthesis in order to prioritise synthesis of other acute phase reactants (3). Additionally, these mediators increase vascular permeability allowing albumin to escape to the extravascular space, which may also lead to low serum albumin levels. Moreover, low serum albumin concentrations in critical illness have been associated with poor outcomes (3).

A meta-analysis of 90 cohort studies with acutely ill patients by Vincent JL et al., showed odds of mortality by 137%, morbidity by 89%, and prolonged hospital stay by 71% (4).

Although the field of COVID-19 research is rapidly growing, few studies have examined the association between hypoalbuminaemia and COVID-19 disease severity and outcome in terms of mortality (5).

Therefore, this retrospective study was conducted to further evaluate the association of hypoalbuminaemia on the severity and outcome of patients with COVID-19.

Material and Methods

The present study was a retrospective study conducted on 200 patients, who were diagnosed with COVID-19 infection and admitted in Kempegowda Institute of Medical Sciences and Research Centre, Bangalore from April 2021 to June 2021 for a duration of two months. Approval for the study was taken from the Institutional Ethics Committee (IEC number KIMS/IEC/A001/M/2022).

Sample size calculation: Sample size estimation was done as follows:

n=Z2(1-α)×PQ / δ2

Z(1-α)=1.96 (for 95% Confidence Interval)

P=0.50 (Based on the probability, that 50% of the COVID non survivor patients will have hypoalbuminaemia as per the previous literature) (3)
Q=1-P
δ (Margin of Error)=0.10
n=96.04, rounded off to 100

Due to the random characteristics among COVID-19 patients, a design effect of 2 was used and the sample size was inflated to 200.

Inclusion criteria: Patients with COVID-19 infection confirmed by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and age more than 18 years were included in the study.

Exclusion criteria: Patients with congestive heart failure, coronary artery disease, malignancy, nephrotic syndrome, chronic liver disease, anaemia, chronic obstructive pulmonary disease, chronic infections like pulmonary tuberculosis and cerebrovascular disease were excluded from the study.

Study Procedure

The severity of COVID-19 was defined according to WHO clinical management guidance of COVID-19 (1). Severe type was defined as SpO2 <90% on room air as per WHO criteria (1). Patients who survived were defined as survivors and patients who died were defined as non survivors for the period of hospital stay between April 2021 to June 2021.

Hypoalbuminaemia was defined as any albumin value <3.5/dL, normal laboratory range in laboratory being 3.5-5.2 g/dL. The primary outcome was to study the severity of the disease and its association with hypoalbuminaemia and secondary outcome was to study the mortality of the disease and its association with hypoalbuminaemia.

The retrospective study was conducted based on patients medical records and study variables were extracted which included age, sex, mean clinical variables and laboratory variables such as Oxygen Saturation (SpO2) and albumin concentration was noted.

Statistical Analysis

Statistical Package for Social Sciences (SPSS) for Windows version 22.0 Released 2013. Armonk, NY: IBM Corp., was used to perform statistical analysis. Descriptive analysis of all the explanatory and outcome parameters were done using frequency and proportions for categorical variables, whereas in mean and Standard Deviation (SD) for continuous variables. Analytical variables were compared using the Chi-square test, level of significance was set at p<0.05. A binary logistic regression analysis was performed to know the true association between hypoalbuminaemia and severity and survival status of the patients with 95% Confidence Interval (CI) for Odds Ratio (OR).

Results

A total of 200 patients with a confirmed diagnosis of COVID-19 by RT-PCR positivity were included in the final analysis after applying all the exclusions. Age, vital parameters were non parametrically distributed.

The mean age of the patients was 53.2 years SD 16.1. The total number of males were 112 (56%) and females were 88 (44%) (Table/Fig 1).

The distribution of co-morbidities among study patients has been shown in (Table/Fig 2).

(Table/Fig 3) shows the distribution of patients based on the clinical severity and outcome, 82 patients (41%) had severe COVID-19 infection and 59 patients (29.5%) were non survivors.

Based on the severity among COVID-19 patients, 56 patients (68.3%) with severe disease had hypoalbuminaemia which was statistically significant with a p-value <0.001, as shown below (Table/Fig 4).

And based on the outcome among COVID-19, out of 200 patients 59 did not survive out of which 47 patients had hypoalbuminaemia which is statistically significant with a p-value of <0.001, as shown below (Table/Fig 5).

Various co-morbidities like hypertension, diabetes mellitus and age of the patient were compared with hypoalbuminaemia and the statistical significance was found with hypoalbuminaemia (Table/Fig 6).

A binary logistic regression analysis was performed to attribute the true association between hypoalbuminaemia and survival status of the patients and the results are presented below (Table/Fig 7).

Discussion

The results of the present study showed a statistically significant association between hypoalbuminaemia upon initial presentation and mortality in the group of patients included in our study, 56 patients (28%) with severe COVID-19 disease had hypoalbuminaemia with a statistically significant p-value <0.001 and 47 patients (23.5%) who did not survive had hypoalbuminaemia with a statistically significant p-value <0.001. The results of the present study are consistent with prior studies that demonstrate a correlation between hypoalbuminaemia and COVID-19 severity (2),(3),(4),(5).

The mean albumin levels in patients with severe disease and non survivors of COVID-19 patients was significantly lesser, mean of 3.5 and 3.37 respectively which was statistically significant with a p-value <0.001, as compared to non severe disease and survivors of COVID-19 infection, mean of 3.89 and 3.88 respectively. The mean difference was statistically significant at p<0.001.

Aziz M et al., performed a meta-analysis of four studies that demonstrated an increased risk for severe COVID-19 with hypoalbuminaemia (6). In a retrospective cohort study of 299 patients, Huang J et al., showed that hypoalbuminaemia was an independent predictor for mortality in COVID-19 patients (2). Abdeen Y et al., in a retrospective study, showed a statistically significant association between hypoalbuminaemia upon initial presentation and mortality in the group of patients included in their study (3). The above findings are consistent with our study.

In this study, it was found that lower albumin levels on admission can predict the outcome of COVID-19 independent of other known indicators such as lymphocyte count or co-morbidities (3),(5).Hypoalbuminaemia was seen predominantly in severe COVID-19 cases compared with mild cases in previous studies and the present study (3),(4),(5),(6),(7),(8),(9),(10),(11),(12),(13),(14).

Albumin infusion has therapeutic efficacy in conditions such as sepsis and cirrhosis through its modulatory effect on inflammation and oxidative stress in addition to plasma expansion (3),(4),(5),(6),(7),(8),(9),(10),(11),(12),(13),(14). Improvement in oxygenation in adult respiratory distress syndrome has been shown in a meta-analysis (10). Albumin treatment could be a potential approach with low side-effect in patients with severe COVID-19 disease, however as majority of patients with severe COVID-19 are elderly with cardiovascular co-morbidities, efficacy and safety of albumin as therapy should be verified in prospective studies (15).

Limitation(s)

The present study was limited by certain factors. Firstly, it was a single-centre study and hence, the results could not be generalised. Secondly, albumin therapy was not used at this centre.

Conclusion

Hypoalbuminaemia was associated with severity and mortality in our study population and could be considered a strong predictor for mortality in hospitalised patients with COVID-19. Hence, initial screening of patients for hypoalbuminaemia and early stratification into low risk and high risk groups and aggressive treatment could prevent COVID-19 severity and mortality.

References

1.
World Health Organization (WHO), Coronavirus disease 2019 (COVID-19) situation report, 51. Available from: https://apps.who.int/iris/handle/10665/331475.
2.
Huang J, Cheng A, Kumar R, Fang Y, Chen G, Zhu Y, et al. Hypoalbuminemia predicts the outcome of COVID-19 independent of age and co-morbidity. J Med Virol [Internet]. 2020;92(10):2152-58. Available from: http://dx.doi.org/10.1002/jmv.26003. [crossref] [PubMed]
3.
Abdeen Y, Kaako A, Ahmad Amin Z, Muhanna A, Josefine Froessl L, Alnabulsi M, et al. The prognostic effect of serum albumin level on outcomes of hospitalized COVID-19 patients. Crit Care Res Pract [Internet]. 2021;2021:9963274. Available from: http://dx.doi.org/10.1155/2021/9963274. [crossref] [PubMed]
4.
Vincent JL, Dubiois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in Acute illness: Is There a Rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Sug. 2003;237(3):319-34. https://doi.org/10.1097/01.SLA.0000055547.93484.87 PMID: 12616115. [crossref] [PubMed]
5.
Kheir M, Saleem F, Wang C, Mann A, Chua J . Higher albumin levels on admission predict better prognosis in patients with confirmed COVID-19. PLoS ONE. 2021;16(3):e0248358. https://doi. org/10.1371/journal.pone.0248358,(2021). [crossref] [PubMed]
6.
Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: A systematic review and meta-analysis. Crit Care. 2020;24(1):255. https://doi.org/10.1186/ s13054-020-02995-3 PMID: 32456658. [crossref] [PubMed]
7.
Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020;92(6):568-76. [crossref] [PubMed]
8.
Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr [Internet]. 2019;43(2):181-93. Available from: http://dx.doi.org/10.1002/jpen.1451. [crossref] [PubMed]
9.
Bohl DD, Shen MR, Kayupov E, Cvetanovich GL, Della Valle CJ. Is hypoalbuminemia associated with septic failure and acute infection after revision total joint arthroplasty? A study of 4517 patients from the national surgical quality improvement program. J Arthroplasty [Internet]. 2016;31(5):963-67. Available from: http://dx.doi.org/10.1016/j.arth.2015.11.025. [crossref] [PubMed]
10.
He Y, Xiao J, Shi Z, He J, Li T. Supplementation of enteral nutritional powder decreases surgical site infection, prosthetic joint infection, and readmission after hip arthroplasty in geriatric femoral neck fracture with hypoalbuminemia. J Orthop Surg Res [Internet]. 2019;14(1):292. Available from: http://dx.doi.org/10.1186/s13018-019-1343-2. [crossref] [PubMed]
11.
Zhang Y, Zheng L, Liu L, Zhao M, Xiao J, Zhao Q. Liver impairment in COVID-19 patients: A retrospective analysis of 115 cases from a single center in Wuhan city, China. Liver Int. 2020;40(9):2095-2103. https:// doi.org/10.1111/liv.14455. [crossref] [PubMed]
12.
Uhlig C, Silva PL, Deckert S, Schmitt J, de Abreu MG. Albumin versus crystalloid solutions in patients with the acute respiratory distress syndrome: A systematic review and meta-analysis. Crit Care [Internet]. 2014;18(1):R10. Available from: http://dx.doi.org/10.1186/cc13187. [crossref] [PubMed]
13.
Zhang C, Huang S, Zheng F, Dai Y. Controversial treatments: An updated understanding of the coronavirus disease 2019. J Med Virol [Internet]. 2020;92(9):1441-48. Available from: http://dx.doi.org/10.1002/jmv.25788. [crossref] [PubMed]
14.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med [Internet]. 2020;382(18):1708-20. Available from: http://dx.doi.org/10.1056/NEJMoa2002032. [crossref] [PubMed]
15.
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J [Internet]. 2020;55(5):2000547. Available from: http://dx.doi.org/10.1183/13993003.00547-2020. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/52394.16366

Date of Submission: Sep 14, 2021
Date of Peer Review: Oct 11, 2021
Date of Acceptance: Apr 29, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 15, 2021
• Manual Googling: Oct 08, 2021
• iThenticate Software: Jan 28, 2022 (19%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com