Abnormal Coagulation Function of Patients With COVID-19 Is Significantly Related to Hypocalcemia and Severe Inflammation

Abstract

This study aimed to detect, analyze, and correlate the clinical characteristics, blood coagulation functions, blood calcium levels, and inflammatory factors in patients with mild and severe COVID-19 infections. The enrolled COVID-19 infected patients were from Wuhan Jin Yin-tan Hospital (17 cases, Wuhan, China), Suzhou Infectious Disease Hospital (87 cases, Suzhou, China), and Xuzhou Infectious Disease Hospital (14 cases, Xuzhou, China). After admission, basic information was collected; X-ray and chest CT images were obtained; and data from routine blood tests, liver and kidney function, myocardial enzymes, electrolytes, blood coagulation function, (erythrocyte sedimentation rate) ESR, C-reactive protein (CRP), IL-6, procalcitonin (PCT), calcitonin, and other laboratory tests were obtained. The patients were grouped according to the clinical classification method based on the pneumonia diagnosis and treatment plan for new coronavirus infection (trial version 7) in China. The measurements from mild (56 cases) and severe cases (51 cases) were compared and analyzed. Most COVID-19 patients presented with fever. Chest X-ray and CT images showed multiple patchy and ground glass opacities in the lungs of COVID 19 infected patients, especially in patients with severe cases. Compared with patients with mild infection, patients with severe infection were older (p = 0.023) and had a significant increase in AST and BUN. The levels of CK, LDH, CK-MB, proBNP, and Myo in patients with severe COVID-19 infection were also increased significantly compared to those in patients with mild cases. Patients with severe COVID-19 infections presented coagulation dysfunction and increased D-dimer and fibrin degradation product (FDP) levels. Severe COVID-19 patients had low serum calcium ion (Ca2+) concentrations and high calcitonin and PCT levels and exhibited serious systemic inflammation. Ca2+ in COVID-19 patients was significantly negatively correlated with PCT, calcitonin, D-dimer, PFDP, ESR, CRP and IL-6. D-dimer in COVID-19 patients was a significantly positively correlated with CRP and IL-6. In conclusion, patients with severe COVID-19 infection presented significant metabolic dysfunction and abnormal blood coagulation, a sharp increase in inflammatory factors and calcitonin and procalcitonin levels, and a significant decrease in Ca2+. Decreased Ca2+ and coagulation dysfunction in COVID-19 patients were significantly correlated with each other and with inflammatory factors.

Predictors of COVID-19 severity among pregnant patients

“…In our study, calcium serum levels were negatively correlated with three measured clinical outcomes: the length of hospitalization (days), the severity of the course of COVID-19 (1-4), and oxygen flow (l/min). These findings were consistent with previously published reports which have showed that low serum calcium levels are associated with disease severity and a poor prognosis for patients with COVID-19 [ 50 - 53 ]. In a study by Zhang et al low serum calcium levels were the most predictive feature of COVID-19 diagnosis of all models tested [ 54 ].…”

“…According to the previous studies, levels of the disease progression indicators CRP, PCT, IL-6, and D-dimer are found to be significantly higher in COVID-19 patients with hypocalcemia. When this is coupled with calcium serum levels which are negatively correlated with these indicators, it means that these patients may have www.bjbms.org a greater inflammatory response [50,51,53]. Secondly, the occurrence of hypocalcemia may be associated with calcium inflow due to hypoxemic tissue damage.…”

Serum Calcium, Magnesium, and Phosphorus Levels in Patients with COVID-19: Relationships with Poor Outcome and Mortality

“…Results of the present paper have been collected in a sample of 2473 patients admitted for COVID-19 in a general hospital. In agreement with previous reports [8][9][10][11][12], our data show that most of the registered comorbidities and laboratory parameters were related to the poor outcome of the disease and to in-hospital mor- This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.…”

The osteo-metabolic phenotype of COVID-19: an update

“…1 ). These mechanisms include calcium-dependent viral mechanisms of action determining intra and extra-cellular cation dysmetabolism [ 22 – 24 ], tissues calcium deposits detected at autoptic evaluation [ 25 ], acute muscle calcium precipitation [ 26 ], calcium role in coagulation and prothrombotic status [ 27 , 28 ], acute malnutrition during critical illness [ 29 ], high levels of unbound and unsaturated fatty acids in inflammatory responses [ 30 ] and high prevalence of hypovitaminosis D with an impaired compensatory PTH response [ 31 ]. Furthermore, severe hypocalcemia, although not frequently found in COVID-19 [ 3 , 13 ], may compromise outcome per se due to its additional negative cardiovascular and neurological impact [ 3 , 13 ].…”