THU332 Composite Glucose And Albumin Biomarker Tool Provides Strong Mortality Risk Assessment At Presentation And Throughout Index COVID-19 Hospitalization
Authors: Torres Rivera Nicole , Baez Rodriguez Karla , Rebernigg Janevi , Contreras Berkis , Yenari Sage , Hamad Karen , Wiese-Rometsch Wilhelmine , Farhangi Vida , Smith Robert 
Published: October 2023

Abstract
Disclosure: N. Torres Rivera: None. K. Baez Rodriguez: None. J. Rebernigg: None. B. Contreras: None. S. Yenari: None. K. Hamad: None. W. Wiese-Rometsch: None. V. Farhangi: None. R. Smith: None.
Mounting evidence demonstrates tempo of SARS-CoV-2 clearance and spike protein neutralization is adversely affected by hyperglycemia and hypoalbuminemia respectively. Serum glucose (SG) and albumin (SA) levels independently have been associated with intensity of hyperinflammation and treatment response in COVID-19 patients. We hypothesized that adults at presentation for index COVID-19 hospitalization evaluated via a composite tool incorporating mortality risk cut points for SG and SA would exhibit an odds ratio (OR) at least included in 95% CI of less frequently measured C-reactive protein (CRP) cut-point. Presentation demographics, administrative data including ICD-10-based Elixhauser comorbidity categories; and laboratory test results were extracted under IRB exemption from electronic medical records. Continuous data summarized with median [IQR] was compared using Kruskal Wallis test. Sequential univariate logistic regression analyses were employed to create a receiver operating characteristic curve with Youden Index estimating cut-point associated with mortality and attendant OR. Discrete data summarized as proportions were compared with chi-square test. Among 6906 consecutively discharged patients between March 2020 and July 2022, 3051 underwent at least one CRP, SG and SA measurement within 24h of index COVID-19 hospitalization with cut-points respectively of &gt;9.2 mg/dL, &gt;133 mg/dL, and &lt;2.9 gm/dL. Patients meeting composite tool (n=789) vs CRP (n=1221) respectively had OR of 4.2 (3.4-5.0) vs 3.2 (2.5-4.0) (p&lt;.05) with 12.6% mortality. Excluding CRP indexing criterion, we expanded sample (n=6074) to characterize value of composite tool for distinguishing patients who lived vs died respectively in 52% vs 66% males (p&lt;.05) and 48% vs 34% females (p&lt;.05) similarly aged 68 [54, 79] years and distributed across Whites (79%), Blacks (9%) and other races (12%). Intergroup comorbidity distribution was similar for hypertension (55%), diabetes (30%), chronic pulmonary disease (21%), thyroid disease (17%) and differed (p&lt;.05) in categories 3[2,5] vs 5[3,6] among obesity (29 vs 48%, BMI 28[24,33] vs 31[26,36]), iron deficiency anemia (21 vs 41%) coagulation disease (15 vs 35%), and renal failure (17 vs 31%). Expanded sample pooled for SG and SA were &gt;128 mg/dL and &lt;2.8 mg/dL. We compared intergroup frequency of positive composite tool triggers vs not and computed a cut point of 51% associated (p&lt;.0001) with mortality. Positive trigger rate of composite tool across hospitalization in patients who died (8 %) vs lived (92%) respectively was 63% vs 24% (p&lt;.0001). Study confirms hyperglycemia and hypoalbuminemia with composite exposure cut point details as traits that may shape host response to SARS-CoV-2 infection. Translational implications suggest value of serial tracking of SG and SA levels as a simple available gauge of COVID-19 progression severity.
Presentation: Thursday, June 15, 2023