Study of serum albumin as a marker of severity in COVID-19 positive SARI and COVID-19 negative SARI patients

Sudha Vasanth, Madhumathi R., Supriyaa Bhakthavatchalam, Kushal M.


Background: COVID-19 a pandemic caused by SARS CoV-2 has caused a wide impact globally. Clinical spectrum of COVID-19 ranges widely including asymptomatic infection, mild upper respiratory tract infection, severe pneumonia, ARDS, MODS and even death. Hypoalbuminemia in COVID-19 indicates severe disease. The aim of the study was to determine incidence of hypoalbuminemia and correlation of severity of hypoalbuminemia with COVID-19 positive SARI and COVID negative SARI patients.

Methods: A study was conducted on 265 SARI patients who were admitted in hospitals attached to BMCRI. History was taken, general physical examination and a detailed systemic examination was done. Patients were categorized into mild, moderate and severe illness.  RT-PCR for COVID-19 patients done using throat and nasal swab. Total WBC counts and differential counts, platelet counts were estimated. Serum albumin levels were correlated with pneumonia severity and compared between COVID-19 positive and Negative SARI. And also, correlation with comorbities was done.

Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. Patients categorized into moderate and severe SARI. Mean age of subjects with COVID-19 positive (severe) was higher- 58.70±15.598 followed by COVID-19 positive (moderate)- 55.13±14.480. About 30% (N=90) were belong to severe SARI group, Chi-square test showed statistical significant association with respect to age. Chi-square test showed no statistical significant association with respect to gender. Independent sample t test showed statistical difference with respect to S. albumin levels between COVID positive and COVID negative subjects. In COVID positive subjects, S. albumin levels showed statistical significant difference between moderate and severe sub groups whereas there was no statistical significant difference seen in COVID negative sub groups.

Conclusions: The relationship between hypoalbuminemia and reduced survival in COVID-19 may have several explanations. First, acting as an anti-inflammatory and antioxidant protein, albumin may protect against cytokine storm. Second, albumin encompasses anticoagulant properties and inhibits oxidative stress-related clotting and platelet activation that occurs in severe COVID-19. Third, albumin is an inverse acute phase reactant. In our present study hypoalbuminemia was more significant in severe COVID-19 positive SARI patients compared to COVID-19 negative SARI patients hence, we could say that hypoalbuminemia is inversely related with COVID-19 severity and also more significant hypoalbuminemia in COVID-19 positive SARI.


Severe pneumonia, Hypoalbuminemia, Antioxidant, Acute phase reactant

Full Text:



Fong SJ, Dey N, Chaki J. Artificial intelligence for coronavirus outbreak. Singapore: Springer; 2020.

Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients. Shock. 2020;54(5):652-8.

Sommerstein R, Fux CA, Vuichard GD, Abbas M, Marschall J, Balmelli C, et al. Risk of SARS-CoV-2 transmission by aerosols, the rational use of masks, and protection of healthcare workers from COVID-19. Antimicrob Resist Infect Control. 2020;9(1):100.

Acharya R, Poudel D, Bowers R, et al. Low Serum Albumin Predicts Severe Outcomes in COVID-19 Infection: A Single-Center Retrospective Case-Control Study. J Clinic Medic Res. 2021;13(5):258-67.

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. 2020;92(10):2152-8.

Violi F, Ceccarelli G, Cangemi R, Alessandri F, Ettorre G, Oliva A, et al. Hypoalbuminemia, Coagulopathy, and Vascular Disease in COVID-19. Circ Res. 2020;127(3):400-1.

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):248358.

Paliogiannis P, Mangoni AA, Cangemi M, Fois AG, Carru C, Zinellu A. Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis. Clin Exp Med. 2021;1-12.

Rica R, Borges M, Aranda M, Del CA, Socias A, Payeras A, et al. Low Albumin Levels Are Associated with Poorer Outcomes in a Case Series of COVID-19 Patients in Spain: A Retrospective Cohort Study. Microorganisms. 2020;8(8):1106.