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. 2021 Dec 2;3(12):e0589.
doi: 10.1097/CCE.0000000000000589. eCollection 2021 Dec.

Evaluation of Albumin Kinetics in Critically Ill Patients With Coronavirus Disease 2019 Compared to Those With Sepsis-Induced Acute Respiratory Distress Syndrome

Chang Su  1 , Katherine L Hoffman  2 , Zhenxing Xu  2 , Elizabeth Sanchez  3 , Ilias I Siempos  4   5 , John S Harrington  3   4 , Alexandra C Racanelli  3   4 , Maria Plataki  3 , Fei Wang  2 , Edward J Schenck  3   4
Affiliations

Evaluation of Albumin Kinetics in Critically Ill Patients With Coronavirus Disease 2019 Compared to Those With Sepsis-Induced Acute Respiratory Distress Syndrome

Chang Su et al. Crit Care Explor. .

Abstract

Objectives: This report aims to characterize the kinetics of serum albumin in critically ill patients with coronavirus disease 2019 compared with critically ill patients with sepsis-induced acute respiratory distress syndrome.

Design: Retrospective analysis.

Setting: We analyzed two critically ill cohorts, one with coronavirus disease 2019 and another with sepsis-induced acute respiratory distress syndrome, treated in the New York Presbyterian Hospital-Weill Cornell Medical Center.

Patients: Adult patients in the coronavirus disease 2019 cohort, diagnosed through reverse transcriptase-polymerase chain reaction assays performed on nasopharyngeal swabs, were admitted from March 3, 2020, to July 10, 2020. Adult patients in the sepsis-induced acute respiratory distress syndrome cohort, defined by Sepsis III criteria receipt of invasive mechanical ventilation and a Pao2/Fio2 ratio less than 300 were admitted from December 12, 2006, to February 26, 2019.

Interventions: None.

Measurements and main results: We evaluated serial serum albumin levels within 30 days after ICU admission in each cohort. We then examined the albumin progression trajectories, aligned at ICU admission time to test the relationship at a similar point in disease progression, in survivors and nonsurvivors. Albumin trajectory in all critically ill coronavirus disease 2019 patients show two distinct phases: phase I (deterioration) showing rapid albumin loss and phase II (recovery) showing albumin stabilization or improvement. Meanwhile, albumin recovery predicted clinical improvement in critical coronavirus disease 2019. In addition, we found a deterioration and recovery trends in survivors in the sepsis-induced acute respiratory distress syndrome cohort but did not find such two-phase trend in nonsurvivors.

Conclusions: The changes in albumin associated with coronavirus disease 2019 associated respiratory failure are transient compared with sepsis-associated acute respiratory distress syndrome and highlight the potential for recovery following a protracted course of severe coronavirus disease 2019.

Keywords: acute respiratory distress syndrome; albumin; coronavirus disease 2019; sepsis.

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Conflict of interest statement

Dr. Wang is supported by National Science Foundation-Information and Intelligent Systems 2027970, 1750326, Office of Naval Research N00014-18-1-2585. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Illustration of albumin trajectories. A, Albumin trajectories (averaged trajectories and two-phase linear mixed-effects model estimated trajectories) of nonsurvivors and survivors of the critically ill coronavirus disease 2019 cohort. B, Albumin trajectories (averaged) of nonsurvivors and survivors of the sepsis-induced acute respiratory distress syndrome cohort.
See this image and copyright information in PMC

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