Abnormal Serum Albumin, Alanine Aminotransferase, and Blood Urea Nitrogen are Associated with Higher Risks for Mechanical Ventilation and In-Hospital Mortality in COVID-19 Positive US Veterans.

Abstract

Background: Since the first reported case of Coronavirus Disease 2019 (COVID-19), clinicians and scientists have been challenged to contrive ideal prevention, detection, and treatment strategies. As the death toll surpasses 1 million in the United States, identifying disease risk factors, specifically those risks related to severe disease manifesting as in-hospital mortality and invasive mechanical ventilation (MV), becomes crucial.

Objectives: This study evaluated the association between abnormal blood biochemical markers, specifically albumin, alanine aminotransferase (ALT), creatinine, serum sodium, and blood urea nitrogen (BUN), to MV and in-hospital mortality in COVID-19 positive United States Veterans.

Design: We performed a retrospective cohort analysis on 298 760 US veterans admitted to any national Veterans Affairs Hospital (VHA) with a positive COVID-19 test from March 1, 2020, to August 31, 2021, resulting in a total of 30 729 patients.

Methods: A selection of patient-specific and COVID-19 test-related data was collected from the COVID-19 Shared Data Resources sourced from the VHA's Corporate Data Warehouse. These data were statistically analyzed using multivariable Cox regression models.

Results: Patients with lower albumin (<3.5 g/L); and higher BUN (>23 mg/dL), creatinine (>1.5 mg/dL), and ALT (>40 U/L) levels had increased risks for MV (29%, 40%, 20%, 26%) and in-hospital mortality (46%, 69%, 23%, 13%), respectively. Interestingly, patients with lower BUN (<11 mg/dL) values had decreased risks for both MV (22%) and in-hospital mortality (31%). Patients with sodium <135 mmol/L had an increased risk for MV and in-hospital mortality (30%, 9%), while sodium >145 mmol/L had an increased risk for in-hospital mortality (125%).

Conclusion: Overall, veterans hospitalized with COVID-19 and having abnormal albumin, ALT, BUN, and creatinine values were statistically associated with ventilatory status and case-fatality.