Decreased prealbumin level is associated with increased risk for mortality in elderly hospitalized patients with COVID-19

Highlights • Low prealbumin concentration was associated with increased risk of worse outcomes (all-cause death, ICU admission and mechanical ventilation) in elderly COVID-19 patients. • There was a negative linear trend correlation between serum prealbumin concentration and risk of worse outcomes in elderly patients with COVID-19 infection. • A low prealbumin concentration can be regarded as a signal identifying the at-risk elderly patient who would suffer worse outcomes and requires careful assessment and monitoring.
Objective: Severe patients tended to have lower serum prealbumin concentration in patients with novel coronavirus (SARS-CoV-2) infected pneumonia (COVID-19). This study was performed to investigate the association of prealbumin at baseline on COVID19-related mortality in elderly patients. Methods: We non-selectively and consecutively collected participants in Tongji Hospital in Wuhan from January 17 to February 17, 2020. Univariate and multivariate logistic regression models were employed to evaluate the correlation between prealbumin and in-hospital outcomes (in-hospital mortality, ICU admission and mechanical ventilation) in elderly COVID-19 patients. Linear trend was performed by entering the median value of each category of prealbumin tertile as continuous variable and was visually confirmed by using generalized additive models. Interaction and stratified analyses were conducted as well. Results: A total of 446 COVID-19 elderly patients were included in the final analyses and the in-hospital mortality was 14.79%. 15.47% patients admitted to intensive care unit and 21.3% patients required mechanical ventilation. Compared with patients in the highest tertile, the prealbumin of patients in the lowest tertile had a 19.09-fold higher risk of death (OR = 20.09; 95% CI, 3.62 to 111.64; P = 0.0006), 25.39-fold higher risk of ICU admission (OR = 26.39; 95% CI, 4.04to 172.39; P = 0.0006) and 1.8-fold higher risk of mechanical ventilation (OR = 2.8; 95% CI, 1.15 to 6.78; P = 0.0227) after adjustment for potential confounders. There was a linear trend correlation between serum prealbumin concentration and risk of in-hospital mortality, ICU admission and mechanical ventilation in elderly patients with COVID-19 infection. Conclusion: Prealbumin is an independent risk factor of the in-hospital mortality for COVID-19 elderly patients. Assessment of prealbumin may help identify high risk elderly individuals with COVID-19.