key: cord-0832416-ztarsl4n
authors: Loffredo, Lorenzo; Campana, Andrea; Olivini, Nicole; Cotugno, Nicola; Palma, Paolo; Oliva, Alessandra; Salvatori, Guglielmo; Zicari, Anna Maria; Violi, Francesco
title: Hypoalbuminemia and clinical adverse events in children with COVID‐19
date: 2021-02-15
journal: J Med Virol
DOI: 10.1002/jmv.26856
sha: 0330eb9797fd7edf0b4310e7be85ec7c3825b7c6
doc_id: 832416
cord_uid: ztarsl4n

Hypoalbuminemia is considered a predictor of adverse outcomes in critically ill children1 and in adults affected by COVID-192, 3 . This article is protected by copyright. All rights reserved.

To the Editor, Hypoalbuminemia is considered a predictor of adverse outcomes in critically ill children 1 and in adults affected by COVID-19. 2, 3 In particular, former studies reported that hypoalbuminemia is a predictor of vascular disease and death. 2, 3 Hypoalbuminemia has been reported in children with a severe form of COVID-19. 4 Conversely, it is unclear whether children with moderate/mild form of COVID-19 have reduced albumin values and if there is an association with inflammatory or infective events. Thus, we wanted to explore this issue in this study.

This study was performed at Bambino Gesù Children's Hospital located in Rome (Italy) and in the dedicated COVID unit. Methods are described in Supporting Information data.

Sixty-three children affected by mild/moderate COVID-19 were consecutively recruited at the Bambino Gesù Children's Hospital in Rome. Clinical characteristics and symptoms at admission are reported in Table 1 .

The median in-hospital stay was 7 days (interquartile range

[IQR] = 5-11). Sixteen patients experienced clinical events: seven multisystem inflammatory syndromes, four pneumonia, three myocardial involvement (troponin increased with ST-segment elevation (n = 1), troponin increase alone (n = 1), pericarditis (n = 1)), and two urinary tract infections. All these clinical events occurred in symptomatic children.

Compared to patients who did not experience clinical events, those with clinical events had lower serum albumin ( Figure 1A ), higher highsensitivity C reactive protein (hs-CRP) and presence of fever at admission (see Table 1 ). Furthermore, serum albumin correlated with hs- COVID-19 infection is characterized by a cytokine storm, which entails systemic inflammation and eventually vascular damage predisposing to thrombosis and death. 5 Albumin is an acute-phase protein, which is reduced during infections because of its anti-inflammatory and antioxidant properties. 6 Its reduction, however, hampers the body's antiinflammatory defense, thus promoting inflammation and eventually leading to multiorgan damage. In this context, it is interesting to note that Tachycardia and chest pain albumin possesses both anticoagulant and antiplatelet activities. Thereby its reduction has been suggested to favor thrombosis. 7 The present study reinforces this concept as we found an inverse correlation between serum albumin and hs-CRP, a marker of systemic inflammation, as well as with clinical outcomes involving lung, heart, and kidney.

In accordance with a previous study, 8 in children with COVID-19 and multisystem inflammatory syndrome.

Our study supports and extends this previous one indicating that hypoalbuminemia occurs in children with multisystem inflammatory syndrome and that low albumin was associated with clinical events.

Another finding of this study is the increased hs-CRP levels in patients with clinical complications. This is in accordance with previous F I G U R E 1 (A) Box and whisker plots of serum albumin in children with (white) and without (dark grey) events. *p < .05. (B) Box and whisker plots of serum albumin in children without clinical events (dark grey), multisystem inflammatory syndrome (white), and with other clinical events (light grey). *p < .05

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