ArticleBiomarker insights2026
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.
Article in Biomarker insights, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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