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.
Keywords: COVID-19; albumin; hepatic injury.
【저자키워드】 COVID-19, albumin, hepatic injury., 【초록키워드】 coronavirus disease, Coronavirus disease 2019, Cytokine storm, Cytokines, Inflammatory responses, Hospitalization, hospital, cytokine, progression, guideline, inflammatory factors, Coagulopathy, Clinical outcome, global pandemic, Retrospective study, serum, Critically ill, clinical, Patient, albumin, death, cholesterol, LDL-C, Inflammatory cytokines, serum albumin, Admission, Critical, liver dysfunction, critically ill patients, Inflammatory cytokine, COVID-19 patients, HDL, LDL, Low-density lipoprotein, hepatotoxicity, Inflammatory response, Concentration, Hypoalbuminemia, leads, low-density lipoproteins, on admission, High-density lipoproteins, partial thromboplastin time, Critically ill patient, interquartile range, Exacerbation, median age, HDL-C, aPTT, Chinese, three groups, lipoprotein, THROMBOPLASTIN, low-density, Tongji Hospital, death group, hepatic injury, significantly lower, survivor, hypoproteinemia, high-density, Wuhan, China, enrolled, occurred, caused, the patient, investigated, clinically, diagnosed, the disease, elevated, activated, reflected, cause, groups, were measured, disease-associated, adult COVID-19 patient, IQR, 【제목키워드】 Hospitalized, albumin, Analysis, poor prognosis, indicate, Decreased,