Hypocalcemia in Covid-19: A Prognostic Marker for Severe Disease

Abstract

Scan to discover onlineBackground & Objective: Previous studies have addressed the electrolyte abnormalities such as hypocalcemia in COVID-19 patients. We aimed to compare the laboratory findings especially the electrolyte levels among COVID-19 patients and healthy controls and evaluate their prognostic values.Methods: This case-control study included 91 COVID-19 patients and 169 healthy individuals. Their laboratory parameters including electrolytes, albumin, liver enzymes, complete blood count, vitamin D, and parathyroid hormone (PTH) were compared. We also analyzed the association between these markers and the major outcomes including severity, mortality and hospitalization.Results: Among patients with COVID-19, 59.3% of the patients had hypocalcemia on admission while in control group only 32.5% had low calcium level (OR=3.02, 95% CI: 1.79-5.13, P<0.001). The rates of death and ICU admission were significantly higher among the patients in hypocalcemic group than those of eucalcemic group (85.7% vs 14.3% and 33.3% Vs 9.1%, respectively). However, there was no significant difference in the mean PTH and vitamin D levels between the two groups. In terms of the severity of the infection, 74.1% of patients in hypocalcemic group had a severe infection while 24.3% of the patients in eucalcemic group were diagnosed with severe infection (OR=8.89, 95% CI: 3.38-23.37, P<0.001).Conclusion: Patients with COVID-19 may present with considerable laboratory abnormalities including hypocalcemia. The hypocalcemia would be also associated with worse major clinical outcome and higher mortality risk.

The effect of low serum calcium level on the severity and mortality of Covid patients: A systematic review and meta‐analysis

“…T lymphocytes are essential to control viral infections. 12,13,22 The results of D-dimer analysis in the present study showed that there is a direct relationship between Ddimer-dimer level and hypocalcemia. The lower the serum calcium level, the significantly higher the D-dimer level and consequently the severity of the disease.…”

“…Among the meta-analysis evaluated studies, seven studies have examined serum calcium levels in healthy individuals and patients with COVID-19. 10,13,[17][18][19][20][21] Also, the relationship between mortality and hypocalcemia in eight articles evaluated, 9,12,13,[22][23][24][25][26] in addition, the relationship between severity of the disease and hypocalcaemia in seven articles evaluated, 13,22,[27][28][29][30][31] and the relationship between hypocalcaemia and the length of hospital stay and admission in the ICU is reported in four and five articles, respectively. 9,12,13,19,22,32 Also, four articles reported hypocalcaemia association with D-dimer level and six articles reported that hypocalcaemia is related to lymphocyte count.…”

“…10,13,[17][18][19][20][21] Also, the relationship between mortality and hypocalcemia in eight articles evaluated, 9,12,13,[22][23][24][25][26] in addition, the relationship between severity of the disease and hypocalcaemia in seven articles evaluated, 13,22,[27][28][29][30][31] and the relationship between hypocalcaemia and the length of hospital stay and admission in the ICU is reported in four and five articles, respectively. 9,12,13,19,22,32 Also, four articles reported hypocalcaemia association with D-dimer level and six articles reported that hypocalcaemia is related to lymphocyte count. 9,12,23,33,34 The mean serum calcium level in the group of patients with COVID-19 was significantly lower than healthy individuals (difference between the mean of the patient group compared to the healthy group was 0.44 and p < .001).…”

“…Many studies showed that hypocalcemia has a direct relationship with increased likelihood of hospitalization, longer hospitalizations, admission to ICU, ventilation, disease severity, increased D-dimer and increased mortality in COVID-19 patients. [10][11][12][13][14] But published studies in this area have some limitations. 15 Therefore, a comprehensive study in this regard is necessary.…”

A review of the possible prognostic values of biochemical changes in patients with SARS-CoV-2 infections

“…Hypokalemia, another complication in COVID-19, can exacerbate acute respiratory distress syndrome (ARDS) and increase the risk of heart injuries (34). Hypocalcemia has also been observed as one of the electrolytes disorders in patients with COVID 19, which if not controlled, can increase mortality rate (35). Syndrome of inappropriate antidiuretic hormone (SIADH) has been reported in some COVID-19 patients and implicated in causing fluids and electrolyte disturbances (36).…”