PT  - JOURNAL ARTICLE
AU  - Johanna S van Zyl
AU  - Amit Alam
AU  - Joost Felius
AU  - Ronnie M Youssef
AU  - Dipesh Bhakta
AU  - Christina Jack
AU  - Aayla K Jamil
AU  - Shelley A Hall
AU  - Göran B Klintmalm
AU  - Cedric W Spak
AU  - Robert L Gottlieb
TI  - ALLY in fighting COVID-19: magnitude of albumin decline and lymphopenia (ALLY) predict progression to critical disease
AID  - 10.1136/jim-2020-001525
DP  - 2021 Mar 01
TA  - Journal of Investigative Medicine
PG  - 710--718
VI  - 69
IP  - 3
4099  - http://hw-f5-jim.highwire.org/content/69/3/710.short
4100  - http://hw-f5-jim.highwire.org/content/69/3/710.full
SO  - J Investig Med2021 Mar 01; 69
AB  - The 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 (Δ) 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 Δ 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.