Low serum albumin and the risk of hospitalization in COVID-19 infection: A retrospective case-control study

Roshan Acharya, Dilli Poudel, Aakash Patel, Evan Schultz, Michael Bourgeois, Rishi Paswan, Scott Stockholm, Macylen Batten, Smita Kafle, Amanda Atkinson, Hafiz Sarwar.

Abstract
The data on the COVID-19 patients who were discharged to self-quarantine is lacking.

Background
Coronavirus disease– 19 (COVID-19) was first reported almost a year ago [1]. Many studies have been done and much has been learned about the disease. The patients who have worse outcomes generally have overwhelming inflammatory response as evidenced by the presence of high levels of inflammatory markers such as c-reactive protein (CRP), interleukin- 6 (IL-6), lactate dehydrogenase (LDH), and ferritin. Those patients are old and have co-morbidities at baseline. Low-level serum albumin was reported in the patients who had worse complications [2–5].

Albumin is one of the major proteins found in the human body that serves as an anti-inflammatory agent [6, 7]. It binds with the reactive oxygen species (ROS) and reactive nitrogen species (RNS) produced during inflammation saving cellular injury [8]. Few studies found that low serum has a direct effect on mortality and worse complications in hospitalized COVID-19 patients [9–11]..

Materials and methods
A single-center, retrospective case-control study. The study was approved by the Cape Fear Valley Medical Center’s Institutional Review Board (IRB ID: 323–20).

Study population
We included patients who presented to ED of a tertiary care hospital and had a discharge diagnosis of ‘COVID-19, virus identified’ (ICD 10 code U07.1) from March 01 to July 31, 2020. We reviewed 796 charts with severe acute respiratory syndrome coronavirus– 2 (SARS-CoV-2) detected on reverse transcriptase-polymerase chain reaction (RT-PCR) of the nasopharyngeal swab. A total of 342 patients were discharged from the ED. Out of those 342, the patients who were i) age ≥18 years old, and ii) had serum albumin documented were included in the study. The final study population included 112 patients.

Discussion
In this single-center study, we found that more than 10% of the patients discharged from ED to self-quarantine needed hospitalization within three weeks. The patients who had normal serum albumin were less likely to need hospitalization after discharge, although the relationships were not statistically significant. The patient with normal serum albumin had fewer co-morbidities compared to patients with low serum albumin.

Conclusion
In this single-center study, the low serum albumin was not associated with the risk of hospitalization in COVID-19 patients who were initially discharged to self-quarantine from the emergency department.

Citation: Acharya R, Poudel D, Patel A, Schultz E, Bourgeois M, Paswan R, et al. (2021) Low serum albumin and the risk of hospitalization in COVID-19 infection: A retrospective case-control study. PLoS ONE 16(4): e0250906. https://doi.org/10.1371/journal.pone.0250906

Editor: Aleksandar R. Zivkovic, Heidelberg University Hospital, GERMANY

Received: February 11, 2021; Accepted: April 16, 2021; Published: April 30, 2021

Copyright: © 2021 Acharya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Data has been uploaded to Dryad Repository at the following: https://doi.org/10.5061/dryad.c59zw3r75. Data is also available and uploaded as Supporting Information.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.