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Ramadori. Hepatoma Res 2020;6:28 I http://dx.doi.org/10.20517/2394-5079.2020.43 Page 7 of 10

Figure 5. Autoradiograph of results of analysis of RNA (Northern) from organs of mice treated intraperitoneally with different amounts of
E. Coli LPS as a model to induce an acute-phase reaction. The filters containing the tissue-RNA were hybridised with radio-actively labelled
cDNAs specific for factor B, for SAA and for actin as control. In all organs factor B- and SAA-gene-expression was up-regulated in a dose-
dependent manner. The different time of exposure of the x-ray film demonstrate the different abundance of gene-expression of factor B and
SAA in the different organs. SAA: serum amyloid A; LPS: lipolysaccharide. J Immunol 1985;135:3645-7. (reprinted with permission) [63]

Physical examination results obtained in hospitalized patients are not reported in the different publications,
but most of the patients who were transferred from the emergency room to the ICU will likely have
presented with clear signs of exsiccosis, hypotension and eventually malnutrition as testified by the low
serum albumin levels. This should be highlighted in the guidelines for the initial supportive management
of patients with COVID-19. If not recognized and promptly treated, progression to the second stage of the
disease, with deterioration in respiratory function, will likely occur.

Patients suffering from mild disease who presented with normal serum albumin levels, even those who have
developed a deterioration, maintained normal serum levels and could be released from the hospital [15,16,65] .

Although albumin administration is not recommended in patients with low serum albumin levels being
[66]
treated in the ICU [35,36] , previous positive experiences with repeated administration of 200-400 mL of
convalescent plasma showed positive effects in some critically ill COVID-19-patients [67-70] . The positive effect
of convalescent plasma infusion could be attributed not only to the COVID-19-specific immunoglobulins,
[71]
but also to the other components of the plasma e.g., albumin .