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Severity of SARS-CoV-2 infection and albumin levels recorded at the first emergency department evaluation: a multicentre retrospective observational study
  1. Gianni Turcato1,
  2. Arian Zaboli1,
  3. Irena Kostic2,
  4. Barbara Melchioretto3,
  5. Laura Ciccariello4,
  6. Eleonora Zaccaria2,
  7. Alessia Olivato3,
  8. Antonio Maccagnani2,
  9. Norbert Pfeifer1,
  10. Antonio Bonora2
  1. 1 Emergency Department, Ospedale di Merano, Merano, Alto Adige, Italy
  2. 2 Emergency Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
  3. 3 Emergency Department, Università degli Studi di Verona Dipartimento di Medicina, Verona, Veneto, Italy
  4. 4 Emergency Department, Ospedale di Bressanone, Bressanone, Trentino Alto Adige, Italy
  1. Correspondence to Dr Gianni Turcato, Emergency Department, Ospedale di Merano, Merano, 39012BZ, Italy; gianni.turcato{at}


Background The aim of this study was to investigate the association between serum albumin levels in the ED and the severity of SARS-CoV-2 infection.

Methods This is a retrospective observational study conducted from 15 March 2020 to 5 April 2020 at the EDs of three different hospitals in Italy. Data from 296 patients suffering from COVID-19 consecutively evaluated at EDs at which serum albumin levels were routinely measured on patients’ arrival in the ED were analysed. Albumin levels were measured, and whether these levels were associated with the presence of severe SARS-CoV-2 infection or 30-day survival was determined. Generalised estimating equation models were used to assess the relationship between albumin and study outcomes, and restricted cubic spline (RCS) regression was used to plot the adjusted dose-effect relationship for possible clinical confounding factors.

Results The mean albumin level recorded on entry was lower in patients with severe SARS-CoV-2 infection than in those whose infections were not severe (3.5 g/dL (SD 0.3) vs 4 g/dL (SD 0.5)) and in patients who had died at 30 days post-ED arrival compared with those who were alive at this time point (3.3 g/dL (SD 0.3) vs 3.8 g/dL (SD 0.4)). Albumin <3.5 g/dL was an independent risk factor for both severe infection and death at 30 days, with adjusted odd ratios of 2.924 (1.509–5.664) and 2.615 (1.131–6.051), respectively. RCS analysis indicated that there was an adjusted dose–response association between the albumin values recorded on ED and the risk of severe infection and death.

Conclusion Albumin levels measured on presentation to the ED may identify patients with SARS-CoV-2 infection in whom inflammatory processes are occurring and serve as a potentially useful marker of disease severity and prognosis.

  • infection
  • emergency department
  • infectious diseases
  • SARS
  • COVID-19

Data availability statement

No data are available.

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  • Handling editor Lara Nicole Goldstein

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  • Contributors GT, AZ, NP, AB, AM, BM and IK contributed to the study concept, study design and acquisition of data. GT, AZ, LC, AO and EZ contributed to data compilation and analysis. GT, AZ, NP, BM, and AB contributed to interpretation of data as well as drafting and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.