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dc.creatorvan Zyl, Johanna S.
dc.creatorAlam, Amit
dc.creatorFelius, Joost
dc.creatorYoussef, Ronnie M.
dc.creatorBhakta, Dipesh
dc.creatorJack, Christina
dc.creatorJamil, Aayla K.
dc.creatorHall, Shelley A.
dc.creatorKlintmalm, Goran B.
dc.creatorSpak, Cedric W.
dc.creatorGottlieb, Robert L.
dc.description.abstractThe global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic leading to coronavirus disease 2019 (COVID-19) is straining hospitals. Judicious resource allocation is paramount but difficult due to the unpredictable disease course. Once hospitalized, discerning which patients may progress to critical disease would be valuable for resource planning. Medical records were reviewed for consecutive hospitalized patients with COVID-19 in a large healthcare system in Texas. The main outcome was progression to critical disease within 10 days from admission. Albumin trends from admission to 7 days were analyzed using mixed-effects models, and progression to critical disease was modeled by multivariable logistic regression of laboratory results. Risk models were evaluated in an independent group. Of 153 non-critical patients, 28 (18%) progressed to critical disease. The rate of decrease in mean baseline-corrected (Delta) albumin was -0.08 g/dL/day (95% CI -0.11 to -0.04; p<0.001) or four times faster, in those who progressed compared with those who did not progress. A model of Delta albumin combined with lymphocyte percentage predicting progression to critical disease was validated in 60 separate patients (sensitivity, 0.70; specificity, 0.74). ALLY (delta albumin and lymphocyte percentage) is a simple tool to identify patients with COVID-19 at higher risk of disease progression when: (1) a 0.9 g/dL or greater albumin drop from baseline within 5 days of admission or (2) baseline lymphocyte of <= 10% is observed. The ALLY tool identified >70% of hospitalized cases that progressed to critical COVID-19 disease. We recommend prospectively tracking albumin. This is a globally applicable tool for all healthcare systems.en_US
dc.publisherBMJ Publishing Group
dc.sourceJournal of Investigative Medicine
dc.subjectserum albuminen_US
dc.subjectrespiratory distress syndromeen_US
dc.subjectcritical careen_US
dc.titleALLY in fighting COVID-19: magnitude of albumin decline and lymphopenia (ALLY) predict progression to critical diseaseen_US
dc.rights.holderAmerican Federation for Medical Research
dc.rights.licenseCC BY-NC 4.0
local.collegeSchool of Medicine
local.departmentInternal Medicine
local.personsGottleib (SOM)

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