SERUM UREA TO ALBUMIN RATIO AS A SIGNIFICANT PREDICTOR OF MORTALITY AMONG PATIENTS OF COVID-19 PNEUMONIA IN THE EARLY DAYS OF ICU ADMISSION

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Background; Covid-19 pneumonia was a pandemic which lead to relentless acute respiratory failure caused by SARS-CoV2 virus. The cytokine storm is responsible for hypoxia and multiorgan failure. Various serum markers have been identified as key factors in the progression to COVID-19 pneumonia. Although pandemic is over after worldwide vaccination by messenger RNA vaccine yet there are still cases being reported to death in few countries of world. Therefore, it is important to further elaborate the key factor like elevated serum urea to albumin ratio for risk stratification and allocation of resources to avoid mortality in COVID-19 pneumonia. Objective: To evaluate the association between the serum urea-to-albumin ratio and the mortality risk in the early days of ICU admission among patients with COVID-19 pneumonia. Methods: This retrospective study was conducted on eighty-two COVID-19 patients hospitalized in the ICU. These patients were admitted to the ICU for at least four days with COVID-19 pneumonia between March 1 and July 30, 2021, at Lahore Health Care Hospital. Diagnosis was confirmed by RT-PCR on nasal swab along with characteristic opacities in both lower lung zones on radiological imaging. Patients were on high-flow oxygen via rebreathing mask, non-invasive positive pressure ventilator support, or mechanical ventilator. Serum albumin levels and urea were measured daily from the first day to the fourth day of ICU admission. Results: Out of 82 patients of COVID-19 pneumonia who remained admitted in the ICU for four days, 38 patients expired. The mean age was 59.1 ± 13.1 years, and 62% (n = 52) were male. Nearly half of the patients (n = 42) were aged 60 years or older. The mean U/A ratio for discharged patients was 13.60 on day 1 and 12.30 on day 4, while for expired patients it was 21.09 on day 1 and 35.06 on day 4. An increased U/A ratio was significantly associated with a higher risk of death (p < 0.001) on both day 1 and day 4, with a stronger correlation observed on day 4 (r = 0.55) compared to day 1 (r = 0.29). Increased age was not correlated with mortality, and no significant association was found between gender and mortality. Conclusion: Elevated serum U/A ratio at admission is a strong predictor of disease severity and mortality in COVID-19 pneumonia. Its routine assessment may aid in early risk stratification and clinical decision-making.

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