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CC BY-NC-ND 4.0 · J Lab Physicians 2023; 15(02): 187-193
DOI: 10.1055/s-0042-1757415
Original Article

Association between Hypocalcemia and Outcome in COVID-19 Patients: A Retrospective Study

Bhagwan Singh Patidar
1   Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Tapasyapreeti Mukhopadhyay 
1   Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Arulselvi Subramanian 
1   Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Richa Aggarwal
2   Department of Anaesthesia, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Kapil Dev Soni
2   Department of Anaesthesia, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Neeraj Nischal
3   Department of Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Debasis Sahoo
2   Department of Anaesthesia, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Surbhi Surbhi
2   Department of Anaesthesia, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Naveet Wig
3   Department of Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Ravindra Mohan Pandey
4   Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
,
Rajesh Malhotra
5   Department of Orthopedics, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
,
Anjan Trikha
1   Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
› Institutsangaben Funding None.
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Abstract

Background Calcium has been shown to play a vital role in the pathophysiology of severe acute respiratory syndrome-coronavirus-2 and middle east respiratory syndrome coronavirus diseases, but less is known about hypocalcemia in coronavirus disease 2019 (COVID-19) patients and its association with the disease severity and the final outcome. Therefore, this study was conducted with an aim to assess clinical features in COVID-19 patients having hypocalcemia and to observe its impact on COVID-19 disease severity and the final outcome.

Methods In this retrospective study, consecutive COVID-19 patients of all age groups were enrolled. Demographical, clinical, and laboratory details were collected and analyzed. On the basis of albumin-corrected calcium levels, patients were classified into normocalcemic (n = 51) and hypocalcemic (n = 110) groups. Death was the primary outcome.

Results The mean age of patients in the hypocalcemic group was significantly lower (p < 0.05). A significantly higher number of hypocalcemic patients had severe COVID-19 infection (92.73%; p < 0.01), had comorbidities (82.73%, p < 0.05), and required ventilator support (39.09%; p < 0.01) compared with normocalcemic patients. The mortality rate was significantly higher in the hypocalcemic patients (33.63%; p < 0.05). Hemoglobin (p < 0.01), hematocrit (p < 0.01), and red cell count (p < 0.01) were significantly lower with higher levels of absolute neutrophil count (ANC; p < 0.05) and neutrophil-to-lymphocyte ratio (NLR; p < 0.01) in the hypocalcemic patients.

Albumin-corrected calcium levels had a significant positive correlation with hemoglobin levels, hematocrit, red cell count, total protein, albumin, and albumin-to-globulin ratio and a significant negative correlation with ANC and NLR.

Conclusion The disease severity, ventilator requirement, and mortality were considerably higher in hypocalcemic COVID-19 patients.

Keywords

calcium - coronavirus - mortality - neutrophil-to-lymphocyte ratio - pandemic

Authors' Contributions

B.S.P. wrote the manuscript; B.S.P., T.M., and A.S. did data analysis; B.S.P., T.M., R.A., K.S., N.N., D.S., and Surbhi helped in data collection, clinical correlation, and interpretation; R.M.P. helped in statistical studies and interpretation; N.W., R.M., and A.T. helped in editing/review of the manuscript. A.S. is guarantee for the study.


Ethical Approval

The study was conducted after obtaining the approval from the Institutional Ethics Committee.




Publikationsverlauf

Artikel online veröffentlicht:
20. Oktober 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: knowledge in progress. Diabetes Res Clin Pract 2020; 162: 108142
    CrossrefPubMedGoogle Scholar
  • 2 World Health Organization. Accessed November 03, 2020 at: https://www.who.int/
  • 3 Ministry of Health & Family Welfare, Government of India. Accessed November 03, 2020 at: https://www.mohfw.gov.in/
  • 4 Pal R, Bhadada SK. COVID-19 and diabetes mellitus: an unholy interaction of two pandemics. Diabetes Metab Syndr 2020; 14 (04) 513-517
    CrossrefPubMedGoogle Scholar
  • 5 Fang Z, Yi F, Wu K. et al. Clinical characteristics of 2019 coronavirus pneumonia (COVID-19): an updated systematic review. MedRxiv 2020; DOI: 10.1101/2020.03.07.20032573.
    CrossrefGoogle Scholar
  • 6 Guan WJ, Ni ZY, Hu Y. et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382 (18) 1708-1720
    CrossrefPubMedGoogle Scholar
  • 7 Goyal P, Choi JJ, Pinheiro LC. et al. Clinical characteristics of Covid-19 in New York city. N Engl J Med 2020; 382 (24) 2372-2374
    CrossrefPubMedGoogle Scholar
  • 8 Zou L, Dai L, Zhang Y. et al. Clinical characteristics and risk factors for disease severity and death in patients with coronavirus disease 2019 in Wuhan, China. Front Med (Lausanne) 2020; 7: 532
    CrossrefPubMedGoogle Scholar
  • 9 Zheng Z, Peng F, Xu B. et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect 2020; 81 (02) e16-e25
    CrossrefPubMedGoogle Scholar
  • 10 Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis 2020; 14: 1753466620937175
    CrossrefPubMedGoogle Scholar
  • 11 Mikhail N, Wali S. Clinical significance of hypocalcemia in COVID-19. Clin Res Diabetes Endocrinol. 2020; 3 (01) 1-3
    Google Scholar
  • 12 Di Filippo L, Formenti AM, Rovere-Querini P. et al. Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19. Endocrine 2020; 68 (03) 475-478
    CrossrefPubMedGoogle Scholar
  • 13 Millet JK, Whittaker GR. Physiological and molecular triggers for SARS-CoV membrane fusion and entry into host cells. Virology 2018; 517: 3-8
    CrossrefPubMedGoogle Scholar
  • 14 Straus MR, Tang T, Lai AL. et al. Ca2+ ions promote fusion of middle east respiratory syndrome coronavirus with host cells and increase infectivity. J Virol 2020; 94 (13) e00426-e20
    CrossrefPubMedGoogle Scholar
  • 15 Sun JK, Zhang WH, Zou L. et al. Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019. Aging (Albany NY) 2020; 12 (12) 11287-11295
    CrossrefPubMedGoogle Scholar
  • 16 Singh VP, Khatua B, El-Kurdi B, Rood C. Mechanistic basis and therapeutic relevance of hypocalcemia during severe COVID-19 infection. Endocrine 2020; 70 (03) 461-462
    CrossrefPubMedGoogle Scholar
  • 17 Yang C, Ma X, Wu J. et al. Low serum calcium and phosphorus and their clinical performance in detecting COVID-19 patients. J Med Virol 2021; 93 (03) 1639-1651
    CrossrefPubMedGoogle Scholar
  • 18 Cappellini F, Brivio R, Casati M, Cavallero A, Contro E, Brambilla P. Low levels of total and ionized calcium in blood of COVID-19 patients. Clin Chem Lab Med 2020; 58 (09) e171-e173
    CrossrefPubMedGoogle Scholar
  • 19 Sankaran RT, Mattana J, Pollack S. et al. Laboratory abnormalities in patients with bacterial pneumonia. Chest 1997; 111 (03) 595-600
    CrossrefPubMedGoogle Scholar
  • 20 Marazuela M, Giustina A, Puig-Domingo M. Endocrine and metabolic aspects of the COVID-19 pandemic. Rev Endocr Metab Disord 2020; 21 (04) 495-507
    CrossrefPubMedGoogle Scholar
  • 21 Chen X, Cao R, Zhong W. Host calcium channels and pumps in viral infections. Cells 2019; 9 (01) 94
    CrossrefPubMedGoogle Scholar
  • 22 Zhou Y, Frey TK, Yang JJ. Viral calciomics: interplays between Ca2+ and virus. Cell Calcium 2009; 46 (01) 1-17
    CrossrefPubMedGoogle Scholar
  • 23 Nieto-Torres JL, Verdiá-Báguena C, Jimenez-Guardeño JM. et al. Severe acute respiratory syndrome coronavirus E protein transports calcium ions and activates the NLRP3 inflammasome. Virology 2015; 485: 330-339
    CrossrefPubMedGoogle Scholar
  • 24 Hu C, Su F, Dai J. et al. Prediction model of severe coronavirus disease 2019 (COVID-19) cases shows the leading risk factor of hypocalcemia. Research Square 2020; DOI: 10.21203/rs.3.rs-41318/v1.
    CrossrefGoogle Scholar
  • 25 Wu Y, Hou B, Liu J, Chen Y, Zhong P. Risk factors associated with long-term hospitalization in patients with COVID-19: a single-centered, retrospective study. Front Med (Lausanne) 2020; 7: 315
    CrossrefPubMedGoogle Scholar
  • 26 Wang B, Li D, Gong Y, Ying B, Cheng B. Association of serum total and ionized calcium with all-cause mortality in critically ill patients with acute kidney injury. Clin Chim Acta 2019; 494: 94-99
    CrossrefPubMedGoogle Scholar
  • 27 Wang B, Gong Y, Ying B, Cheng B. Association of initial serum total calcium concentration with mortality in critical illness. BioMed Res Int 2018; 2018: 7648506
    PubMedGoogle Scholar
  • 28 Bullard Z, Dattero J, Zimmerman LH, Steelman J, Jurado L. Assessment of pulmonary arterial pressure using critical care echocardiography: dealing with the yin and the yang?. Crit Care Med 2019; 47 (01) 126
    CrossrefPubMedGoogle Scholar
  • 29 Velayoudom FL, Alwis Wijewickrama PS, Ranathunga HI, Somasundaram N. Endocrine vigilance in COVID-19. J Pak Med Assoc 2020; 70 (05) S83-S86
    Google Scholar
  • 30 Thongprayoon C, Cheungpasitporn W, Chewcharat A, Mao MA, Kashani KB. Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA. BMJ Open 2020; 10 (03) e034325
    CrossrefPubMedGoogle Scholar
  • 31 Singh VP, Khatua B, El-Kurdi B. Hypocalcemia and hypoalbuminemia during COVID-19 infection: opportunities for therapeutic intervention. J Infect Public Health 2020; 13 (12) 1887
    CrossrefPubMedGoogle Scholar