Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019: a retrospective cross-sectional study

Abstract

Background: To investigate the correlations between serum calcium and clinical severity and outcomes in patients with coronavirus disease 2019 (COVID-19).Methods: In this clinical retrospective study, the levels of serum calcium, hormone levels and clinical laboratory parameters of admission were recorded. The clinical severity and outcome variables were also recorded.Results: From February 10 to February 28 2020, 241 patients were enrolled in this study. Of these patients, 180 (74.7%) had hypocalcemia on admission. The median serum calcium levels were 2.12 (IQR, 2.04-2.20) mmol/L, median parathyroid hormone (PTH) levels were 55.27 (IQR, 42.73-73.15) pg/mL, median 25-hydroxy-vitamin D (VD) levels were 10.20 (IQR, 8.20-12.65) ng/mL. The serum calcium levels were significantly positive correlated with VD levels (P =0.004), whereas negative correlated with PTH levels (P = 0.048). Patients with lower serum calcium levels (especially ≤2.0 mmol/L) had worse clinical parameters, higher incidence of organ injury septic shock and higher 28-day mortality. The areas under the receiver operating characteristic curves of multiple organ dysfunction syndrome, septic shock, and 28-day mortality were 0.923 (P <0.001), 0.905 (P =0.001), and 0.929 (P <0.001), respectively. The overall mortality of COVID-19 was 4.1% (10/241), whereas the mortality of critical patients was up to 40.0% (10/25). Conclusions: Serum calcium was associated with clinical severity and prognosis of patients with COVID-19. Hypocalcemia may be associated with imbalanced VD and PTH.

Value of laboratory tests in COVID-19 hospitalized patients for clinical decision-makers: a predictive model, using data mining approach

“…Abnormal serum electrolytes (calcium, potassium, and sodium) were also among the risk factors associated with COVID-19 MR. Concerning serum calcium, the herein results are consistent with previous reports on COVID-19 which have stated that patients with hypocalcemia have more severe symptoms and mortality rates than others [28]. This is attributable to the role of calcium in immune response development [12].…”

“…Although, an elevated amount of alanine aminotransferase (ALT), aspartate aminotransferase (AST), Creactive protein (CRP), lactate dehydrogenase, d-dimer, and low serum concentrations of albumin, sodium, potassium and calcium were reported to be associated with disease severity, unfavorable prognosis and mortality rate, most of these articles were limited to a speci c population or a small sample size. Moreover, there are still other potential explanatory variables that require further assessment [28,33,37].…”

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

“…Sun et al, conducted a 241 patient retrospective chart review in a hospital in Wuhan, China, using standardized definitions of mild, moderate, severe, and critical COVID-19 (219). On admission, 74.7% of patients were hypocalcemic (219).…”

“…Sun et al, conducted a 241 patient retrospective chart review in a hospital in Wuhan, China, using standardized definitions of mild, moderate, severe, and critical COVID-19 (219). On admission, 74.7% of patients were hypocalcemic (219). Noting that vitamin D deficiency can cause hypocalcemia, the researchers found a median 25(OH)D of 10.20 ng/ml (severe deficiency) among the 26 patients tested; none were vitamin D sufficient (219).…”

“…On admission, 74.7% of patients were hypocalcemic (219). Noting that vitamin D deficiency can cause hypocalcemia, the researchers found a median 25(OH)D of 10.20 ng/ml (severe deficiency) among the 26 patients tested; none were vitamin D sufficient (219). These 26 patients had worse CRP (p < 0.001), D-dimer (p < 0.001), and parathyroid hormone (p = 0.048) levels (219).…”