Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical

Abstract

Background: Coronavirus disease 2019 (COVID-19) virus is still spreading, finding out the initial hits of viral infection is important to minimize the mild/moderate population, prevent disease aggravation and organs dysfunction. Objective: We investigated COVID-19 patients with different serum calcium levels. Design: We checked the serum calcium level of the patients based on days after symptom onset as well as the severity of COVID-19. We also checkeed multi-organ injuries and immune cytokines level in their blood. Results: Both mild/moderate and severe critical cases we observed showed low calcium level in the early stage of viral infection, while the severe/critical cases showed significant lower calcium level than mild/moderate cases in the early stage. We also found that low calcium level related to severe/critical multi-organ injuries especially in the mild/moderate population. Proinflammatory cytokine IL-6 also correlated to calcium change in both mild/moderate and severe/critical cases. Conclusions: Our finding indicates that calcium balance is a primal hit of COVID-19 and a biomarker of clinical severity at the beginning of symptom onset. Calcium is closely associated with virus-associated multiple organ injuryes and the increase of inflammatory cytokines. Our results provide a new, important indicator of COVID-19 patients from mild/moderate to severe/critical: serum calcium.

Clinical Variants, Characteristics, and Outcomes Among COVID-19 Patients: A Case Series Analysis at a Tertiary Care Hospital in Karachi, Pakistan

“…Serum calcium was estimated only in patients who complained of muscle cramps and was found to be relatively low amongst patients in the severe category compared to mild or moderate cases, in keeping with another published study [19]. Furthermore, neutrophil, creatinine, ALT, and AST levels were also altered amongst COVID-19 patients in relation to disease severity and outcomes, which has also been reported by other similar studies [19][20].…”

“…The novel coronavirus disease 2019 (COVID- 19) is a rapidly disseminating viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been identified as a member of a large family of enveloped ribonucleic acid (RNA) viruses (Coronaviridae) responsible for causing various respiratory tract infections among humans [1].…”

“…Several studies have reported alterations in various biochemical parameters among COVID-19 sufferers throughout the disease course. Lymphocytopenia, thrombocytopenia, leukopenia, high levels of CRP, alanine transaminase (ALT), aspartate aminotransferase (AST), creatine phosphokinase (CPK), and D-dimer are among the laboratory findings that have been recorded among the majority of the COVID-19 clinical studies [18][19][20][21]. These variables have been identified as significant clinical predictors of the severity of SARS-CoV-2 viral infection.…”

Serum Zinc, Copper, and Other Biometals Are Associated with COVID-19 Severity Markers

“…Serum total Se and selenoprotein P levels were found to be associated with improved outcome in COVID-19 cases [ 16 ]. In turn, Ca levels were also found to be lower in critical illness, being associated with inflammatory cytokine levels and COVID-19-associated organ damage [ 17 ]. At the same time, data from comparative analysis of the association between biologically essential metals and multiple markers of COVID-19 severity are lacking.…”

Calcium channels and their role in regenerative medicine

“…Low serum Ca 2 + indicates that Ca 2 + -balance is the primary target of COVID-19. Ca 2 + balance, a biomarker of clinical severity, is associated with virus-associated multiple organ injuries, and an increase in inflammatory cytokines[ 90 ]. Ca 2 + channel blockers, also called antihypertensive drugs such as ACE inhibitors and angiotensin II receptor blockers, inhibited the post-entry replication events of SARS-CoV-2 in vitro.…”