Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19

Abstract

Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), presents primarily with fever, dry cough, and fatigue or myalgia [1]. Although most patients have a favorable prognosis, infection may not infrequently lead to a severe syndrome requiring hospitalization and assisted ventilation with high lethality [2]. Previous studies have reported that calcium played a central role in viral infectious and replicative mechanisms of SARS-CoV, MERS-CoV, and Ebolavirus [3-5]. In a large group of SARS patients in North America, hypocalcemia was detected in 60% of patients at hospital admission and in 70% during hospitalization [6]. Moreover, data from patients with Ebolavirus infection in United States and European hospitals reported a similar incidence of hypocalcemia [7]. Several studies investigated so far the clinical and laboratory characteristics of COVID-19 patients, including inflammatory and organ injury biomarkers [8]. Recently, we have reported the first case of COVID-19 presenting with severe hypocalcemia [9]. However, no population data are available on calcium levels in COVID-19 [10].

Hypocalcemia is a distinctive biochemical feature of hospitalized COVID-19 patients

“…A total of 20 non-COVID-19 patients were included in the study. These patients were matched with 20 COVID-19 patients (part of a previously reported cohort [ 1 ]) for the following known prognostic factors: age, sex, and concomitant comorbidities distribution.…”

“…Hypocalcemia has been recently identified as one of the major biochemical features of COVID-19 patients [ 1 – 7 ].…”

“…To date, several studies reported high frequency of hypocalcemia with both low ionized and total calcium levels in different cohorts of COVID-19 patients in emergency departments (ED) and during hospitalization. In some instances, also severe cases of hypocalcemia were reported [ 1 – 7 ]. Moreover, a strong association between lower calcium and higher levels of inflammatory parameters with increased disease severity has also been reported [ 1 ].…”

“…In some instances, also severe cases of hypocalcemia were reported [ 1 – 7 ]. Moreover, a strong association between lower calcium and higher levels of inflammatory parameters with increased disease severity has also been reported [ 1 ]. Finally, some authors identified hypocalcemia as a relevant and independent risk factor for worse clinical outcome including rate of hospitalization, ICU admission, and mortality [ 1 , 5 , 6 ].…”

Endocrinology and Covid-19: A Multifaceted Interaction

“…43 A recent single-center study documented hypocalcemia in a significant proportion of COVID-19 infected patients, and it was a risk factor for the need for hospitalization, ICU admission and mortality. 46 Therefore, in sick patients, measurement of serum calcium and appropriate supplementation should be considered.…”