Prognostic value of hypocalcemia in COVID-19

Abstract

Background: Preliminary data suggest that hypocalcemia is common among patients with coronavirus 2019 admitted to the hospital.Objective: To examine the prognostic value of hypocalcemia in the setting of COVID-19.Methods: Literature search (Pubmed) until September 15, 2020. Search terms include hypocalcemia, COVID-19, mortality, complications. Retrospective studies are reviewed due to lack of randomized trials.Results: Hypocalcemia is the most common electrolyte abnormality in patients with COVID-19 admitted to the hospital after hyponatremia. Prevalence of hypocalcemia among hospitalized patients with COVID-19 ranges from 9.5% to 78% depending on the definition of hypocalcemia and patients' characteristics. In most cases, hypocalcemia is mild to moderate biochemically. Hypocalcemia is a risk factor for hospitalization of patients with COVID-19. In already hospitalized patients, hypocalcemia is significantly associated with increase severity of COVID-19 and its complications including multi-organ failure, intensive care unit (ICU) admission, need for mechanical ventilation, acute respiratory distress syndrome (ARDS), and death. Hypocalcemia is significantly correlated with inflammatory markers of COVID-19. Causes of hypocalcemia in COVID-19 patients are unclear, but vitamin D deficiency may be a contributing factor. Conclusions: Hypocalcemia is common in hospitalized patients with COVID-19 and carries unfavorable outcomes. Further studies are needed to examine causes of hypocalcemia in COVID-19 and to see whether normalization of circulating calcium levels improve prognosis.

Comparison of trace element (selenium, iron), electrolyte (calcium, sodium), and physical activity levels in COVID-19 patients before and after the treatment

“…However, the role of hypocalcemia in COVID-19 infection is not fully known yet. It can be speculated that the "consumption" of circulating Ca for the virus to enter the host cells, as noted by Mikail and Mali [52] , may contribute to hypocalcemia. Tezcan et al reported that low basal Ca levels are associated with higher mortality rates, higher intensive care unit and mechanical ventilation requirements, and more extended hospital stay [53] .…”

Prognostic implication of hypocalcaemia in COVID-19: a systematic review

“…In a review by Mikhail et al, (40), the frequency of hypocalcaemia among patients with COVID-19 was reported to be 9.5-78%. In the general population, common causes of hypocalcaemia include chronic kidney disease, vitamin D deficiency, hypomagnesaemia, drugs and hypoparathyroidism (41).…”

“…In the general population, common causes of hypocalcaemia include chronic kidney disease, vitamin D deficiency, hypomagnesaemia, drugs and hypoparathyroidism (41). So far, the exact cause (s) of hypocalcaemia in COVID-19 patients is/ are not known (40). However, some plausible hypotheses have been proposed.…”

Pathophysiological and laboratory aspects of hemostatic disorders in patients with COVID-19

“…This "consumption" of Ca 2+ for the virus entry into cells might contribute to hypocalcemia and more pronounced inflammation, which further stimulates the activity of the coagulation cascade. Expectedly, multiple studies have shown significant association between hypocalcemia and inflammatory markers that reflect the severity of COVID-19 (37).…”