Association between hypoalbuminemia and pulmonary CT severity in COVID-19 ICU patients: A cohort study

Abstract English: Background: Hypoalbuminemia is recognised as a significant prognostic factor in critically ill coronavirus disease 2019 (COVID-19) patients. This study investigates the association between serum albumin levels and pulmonary computed tomography (CT) severity, as well as patient outcomes, including mortality, in intensive care unit (ICU)-admitted COVID-19 patients. Methods: This cohort study was conducted between March 2020 and October 2021 at Imam Reza Hospital, Iran. ICU-admitted COVID-19 patients were evaluated for demographic characteristics, clinical and laboratory parameters, lung CT findings with severity scoring and outcomes. Data analysis was performed using SPSS version 25. Results: Among 200 patients (mean age: 63.6 ± 16.1 years; 58% male), 80.0% (n = 160) presented with hypoalbuminemia. The average initial serum albumin level was 3.13 ± 0.49 g/dL. The overall mortality rate was 81% (n = 162). Survivors had significantly higher albumin levels (P = 0.003) compared to non-survivors. Based on multivariable logistic regression, higher serum albumin was associated with a 61% reduction in mortality odds (OR = 0.39, 95% CI: (0.18, 0.90), P = 0.027). However, no statistically significant correlation was found between serum albumin levels and pulmonary CT severity scores. Conclusion: Hypoalbuminemia in ICU COVID-19 patients is strongly associated with poor clinical outcomes and increased mortality, but not with the radiological extent of lung involvement seen on CT imaging.