Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a newly emerged pathogen with high morbidity and mortality. Laboratory testing is essential in assessing disease severity. Pre-albumin (PAB) is used as a marker of nutrition and found as a negative acute phase protein, decreased markedly in Coronavirus disease 2019 (COVID-19) patients. The aim of the paper measures the serum PAB level in Egyptian patients infected with COVID-19 and correlate its level with clinical, lab biomarkers severity and outcome. The study was conducted at Al-Zahraa University Hospital and the National Research Institute of Tropical Medicine Cairo from March 2021 to August 2021. This study included 90 patients aged above 18 years, divided into 3 groups according to severity (mild, moderate, and severe), each group involved 30 patients who were further classified according to outcome into survived and non-survivors. Serum PAB is markedly decreased in severe COVID-19 patients in comparison to mild and moderate groups with a cut of point between mild and moderate is ≤ 164.2 with a sensitivity of 66.67 and a specificity of 96.5 and cut off point between moderate and severe groups ≤ 130with sensitivity of 55.17and specificity of 76.67. Serum PAB levels decreased in non-survivor patients in comparison to surviving patients. There was a negative correlation between serum PAB and inflammatory markers. Serum PAB is a negative acute phase protein that significantly decreased in severe COVID-19 patients and un-survived patients. It can be used as a marker for covid-19 severity. A single use of PAB could achieve a modest prediction performance for the prognosis of COVID-19. When combined with other conventional laboratory indicators, PAB could produce a better performance.