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ORIGINAL ARTICLE  COVID-19 SECTION Open accessopen access

Italian Journal of Emergency Medicine 2021 April;10(1):17-23

DOI: 10.23736/S2532-1285.21.00078-1

Copyright © 2021 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

Serum albumin, clotting activation and COVID-19 severity: a systematic review and meta-regression analysis of 4579 patients

Danilo MENICHELLI 1, Arianna DI ROCCO 2, Francesco DEL SOLE 1, Pasquale PIGNATELLI 1, Annarita VESTRI 2, Francesco VIOLI 1, Daniele PASTORI 3

1 Department of Clinical Internal, Anesthesiologic, and Cardiovascular Sciences, I Clinica Medica, Atherothrombosis Center, Sapienza University, Rome Italy; 2 Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; 3 Unit of Emergency Medicine, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy

BACKGROUND: Preliminary data showed that serum albumin (SA), an acute phase protein with anticoagulant property, is inversely associated with thrombotic complications in respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection associated disease (COVID-19). We performed a meta-analysis to corroborate this finding on a large sample population.
METHODS: We performed a systematic review and meta-regression analysis of clinical studies reporting data on SA according to the severity of COVID-19 disease. COVID-19 severity was defined as: 1) admission to the Intensive Care Unit; 2) acute respiratory distress syndrome; or 3) in-hospital death.
RESULTS: We included 16 studies with 4,579 patients with SARS-CoV-2 infection. Mean age was 51.5 years, and 2146 (44.2%) of patients were women. Overall, 1199 (31.3%) of patients had severe COVID-19 (range 5.4% to 72.6%). Mean SA level was 37.15 g/L. The pooled analysis showed a mean difference of SA: -4.06 g/L (95% CI -4.98/-3.15) in severe COVID-19 compared to non-severe ones. This difference ranged from -7.10 g/L to 1.09 g/L. At meta regression analysis, the difference in SA levels between severe and non-severe COVID-19 patients was more evident in studies with high D-Dimer (P<0.001) and procalcitonin (P=0.07), suggesting a more SA reduction in patients with thrombotic/septic disease.
CONCLUSIONS: SA is significantly reduced in severe COVID-19 and associated with elevated D-Dimer. Albumin supplementation may be tested as adjunctive therapeutic strategy to reduce the thrombotic risk.

KEY WORDS: Albumins; COVID-19; SARS-CoV-2

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