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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 under the CC BY-NC-ND license

lingua: Inglese

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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