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The relationship between disease prognosis and serum calcium and corrected calcium levels in COVID-19 patients

Year 2021, Volume 7, Issue 5, 515 - 523, 04.09.2021
https://doi.org/10.18621/eurj.940798

Abstract

Objectives: The present study aimed to evaluate whether low serum calcium (Ca) and corrected calcium (cCa) levels could predict disease prognosis and mortality in patients with COVID-19.

Methods: In this study, we retrospectively enrolled 206 eligible patients with COVID-19, diagnosed at Turkey Kanuni Sultan Süleyman Training and Research Hospital between March 12, 2020 and June 15, 2020.

Results: Serum Ca level was 8.8 ± 0.57 mg/dL and the serum cCa level was 8.99 ± 0.53 in all patients. The patients were divided into two groups, such as hypocalcemic and non-hypocalcemic patients. We observed that serum Ca levels of patients who died were significantly lower than that of surviving patients. A significant negative correlation was found between serum cCa level and albumin level. A significant positive correlation was found between serum cCa level and C-reactive protein, lactate dehydrogenase, ferritin, procalcitonin, troponin, CURB-65 score, and quick Sepsis-related Organ Failure Assessment (q-SOFA) score. Univariate logistic regression analysis revealed that age, respiratory rate, saturation, heart rate, lymphocyte, serum calcium, D-dimer, CURB-65 score, and q-SOFA score were independent predictors of high-risk group of mortality.

Conclusions: This study confirms that the severity of COVID-19 is associated with lower concentrations of serum Ca. The cCa levels were associated with certain prognostic factors. Serum Ca and cCa levels could be an early and helpful marker to improve management of patients with COVID-19. We recommend evaluation of calcium in patients on initial presentation and serial monitoring during hospitalization in order to perform timely and appropriate corrective actions.

References

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  • 2. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565-74.
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  • 6. Nasiri MJ, Haddadi S, Tahvildari A, Farsi Y, Arbabi M, Hasanzadeh S, et al. COVID-19 clinical characteristics, and sex-specific risk of mortality: systematic review and meta-analysis. Front Med (Lausanne) 2020;7:459.
  • 7. Li X, Wang L, Yan S, Yang F, Xiang L, Zhu J, et al. Clinical characteristics of 25 death cases with COVID-19: a retrospective review of medical records in a single medical center, Wuhan, China. Int J Infect Dis 2020;94:128-32.
  • 8. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al; China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55:2000547.
  • 9. Cao J, Tu WJ, Cheng W, Yu L, Liu YK, Hu X, et al. Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China. Clin Infect Dis 2020;71:748-55.
  • 10. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2.
  • 11. Mikami T, Miyashita H, Yamada T, Harrington M, Steinberg D, Dunn A, et al. Risk factors for mortality in patients with COVID-19 in New York City. J Gen Intern Med 2021;36:17-26.
  • 12. Prasad N, Gopalakrishnan N, Sahay M, Gupta A, Agarwal SK; COVID-19 Working Group of Indian Society of Nephrology. Epidemiology, genomic structure, the molecular mechanism of injury, diagnosis and clinical manifestations of coronavirus infection: an overview. Indian J Nephrol 2020;30:143-54.
  • 13. Zhou Y, Frey TK, Yang JJ. Viral calciomics: interplays between Ca2+ and virus. Cell Calcium 2009;46:1-17.
  • 14. Olivier M. Modulation of host cell intracellular Ca2+. Parasitol Today 1996;12:145-50.
  • 15. Nieto-Torres JL, DeDiego ML, Verdiá-Báguena C, Jimenez-Guardeño JM, Regla-Nava JA, Fernandez-Delgado R, et al. Severe acute respiratory syndrome coronavirus envelope protein ion channel activity promotes virus fitness and pathogenesis. PLoS Pathog 2014;10:e1004077.
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  • 17. Catalano A, Chilà D, Bellone F, Nicocia G, Martino G, Loddo I, et al. Incidence of hypocalcemia and hypercalcemia in hospitalized patients: is it changing? J Clin Transl Endocrinol 2018;13:9-13.
  • 18. Cheungpasitporn W, Thongprayoon C, Mao MA, Kittanamongkolchai W, Sakhuja A, Erickson SB. Impact of admission serum calcium levels on mortality in hospitalized patients. Endocr Res 2018;43:116-23.
  • 19. Akirov A, Gorshtein A, Shraga-Slutzky I, Shimon I. Calcium levels on admission and before discharge are associated with mortality risk in hospitalized patients. Endocrine 2017;57:344-51.
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  • 21. Sun JK, Zhang WH, Zou L, Liu Y, Li JJ, Kan XH, et al. Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019. Aging (Albany NY) 2020;12:11287-95.
  • 22. 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:e171-3.
  • 23. Di Filippo L, Formenti AM, Rovere-Querini P, Carlucci M, Conte C, Ciceri F, et al. Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19. Endocrine 2020;68:475-8.
  • 24. Bossoni S, Chiesa L, Giustina A. Severe hypocalcemia in a thyroidectomized woman with Covid-19 infection. Endocrine 2020;68:253-4.
  • 25. Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem 2020;57:262-5.
  • 26. Cao M, Zhang D, Wang Y, Lu Y, Zhu X, Li Y, al. Clinical features of patients infected with the 2019 novel coronavirus (COVID-19) in Shanghai, China. medRxiv. 2020 Mar; 6. doi: https://doi.org/10.1101/2020.03.04.20030395.
  • 27. Yesiltepe Mutlu G, Hatun S. Use of vitamin D in children and adults: frequently asked questions. J Clin Res Pediatr Endocrinol 2018;10:301-6.
  • 28. Khamis F, Al-Zakwani I, Al Naamani H, Al Lawati S, Pandak N, Omar MB, et al. Clinical characteristics and outcomes of the first 63 adult patients hospitalized with COVID-19: an experience from Oman. J Infect Public Health 2020;13:906-13.
  • 29. Hoechter DJ, Becker-Pennrich A, Langrehr J, Bruegel M, Zwissler B, Schaefer S, et al. Higher procoagulatory potential but lower DIC score in COVID-19 ARDS patients compared to non-COVID-19 ARDS patients. Thromb Res 2020;196:186-92.
  • 30. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
  • 31. Nguyen Y, Corre F, Honsel V, Curac S, Zarrouk V, Fantin B, et al. Applicability of the CURB-65 pneumonia severity score for outpatient treatment of COVID-19. J Infect 2020;81:e96-8.
  • 32. Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep vein thrombosis in hospitalized patients with COVID-19 in Wuhan, China: prevalence, risk Factors, and outcome. Circulation 2020;142:114-28.
  • 33. Rivera-Izquierdo M, Del Carmen Valero-Ubierna M, R-delAmo JL, Fernández-García MÁ, Martínez-Diz S, Tahery-Mahmoud A, et al. Sociodemographic, clinical and laboratory factors on admission associated with COVID-19 mortality in hospitalized patients: a retrospective observational study. PLoS One 2020;15:e0235107.

Year 2021, Volume 7, Issue 5, 515 - 523, 04.09.2021
https://doi.org/10.18621/eurj.940798

Abstract

References

  • 1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
  • 2. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565-74.
  • 3. Aly MH, Rahman SS, Ahmed WA, Alghamedi MH, Al Shehri AA, Alkalkami AM, et al. Indicators of critical illness and predictors of mortality in COVID-19 patients. Infect Drug Resist 2020;13:1995-2000.
  • 4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
  • 5. Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ 2020;369:m1966.
  • 6. Nasiri MJ, Haddadi S, Tahvildari A, Farsi Y, Arbabi M, Hasanzadeh S, et al. COVID-19 clinical characteristics, and sex-specific risk of mortality: systematic review and meta-analysis. Front Med (Lausanne) 2020;7:459.
  • 7. Li X, Wang L, Yan S, Yang F, Xiang L, Zhu J, et al. Clinical characteristics of 25 death cases with COVID-19: a retrospective review of medical records in a single medical center, Wuhan, China. Int J Infect Dis 2020;94:128-32.
  • 8. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al; China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020;55:2000547.
  • 9. Cao J, Tu WJ, Cheng W, Yu L, Liu YK, Hu X, et al. Clinical features and short-term outcomes of 102 patients with coronavirus disease 2019 in Wuhan, China. Clin Infect Dis 2020;71:748-55.
  • 10. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2.
  • 11. Mikami T, Miyashita H, Yamada T, Harrington M, Steinberg D, Dunn A, et al. Risk factors for mortality in patients with COVID-19 in New York City. J Gen Intern Med 2021;36:17-26.
  • 12. Prasad N, Gopalakrishnan N, Sahay M, Gupta A, Agarwal SK; COVID-19 Working Group of Indian Society of Nephrology. Epidemiology, genomic structure, the molecular mechanism of injury, diagnosis and clinical manifestations of coronavirus infection: an overview. Indian J Nephrol 2020;30:143-54.
  • 13. Zhou Y, Frey TK, Yang JJ. Viral calciomics: interplays between Ca2+ and virus. Cell Calcium 2009;46:1-17.
  • 14. Olivier M. Modulation of host cell intracellular Ca2+. Parasitol Today 1996;12:145-50.
  • 15. Nieto-Torres JL, DeDiego ML, Verdiá-Báguena C, Jimenez-Guardeño JM, Regla-Nava JA, Fernandez-Delgado R, et al. Severe acute respiratory syndrome coronavirus envelope protein ion channel activity promotes virus fitness and pathogenesis. PLoS Pathog 2014;10:e1004077.
  • 16. Nieto-Torres JL, Verdiá-Báguena C, Jimenez-Guardeño JM, Regla-Nava JA, Castaño-Rodriguez C, Fernandez-Delgado R, et al. Severe acute respiratory syndrome coronavirus E protein transports calcium ions and activates the NLRP3 inflammasome. Virology 2015;485:330-9.
  • 17. Catalano A, Chilà D, Bellone F, Nicocia G, Martino G, Loddo I, et al. Incidence of hypocalcemia and hypercalcemia in hospitalized patients: is it changing? J Clin Transl Endocrinol 2018;13:9-13.
  • 18. Cheungpasitporn W, Thongprayoon C, Mao MA, Kittanamongkolchai W, Sakhuja A, Erickson SB. Impact of admission serum calcium levels on mortality in hospitalized patients. Endocr Res 2018;43:116-23.
  • 19. Akirov A, Gorshtein A, Shraga-Slutzky I, Shimon I. Calcium levels on admission and before discharge are associated with mortality risk in hospitalized patients. Endocrine 2017;57:344-51.
  • 20. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance, 25 January 2020 (2020). Available from: https://apps.who.int/iris/handle/10665/3308 [Accessed 30 March2020].
  • 21. Sun JK, Zhang WH, Zou L, Liu Y, Li JJ, Kan XH, et al. Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019. Aging (Albany NY) 2020;12:11287-95.
  • 22. 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:e171-3.
  • 23. Di Filippo L, Formenti AM, Rovere-Querini P, Carlucci M, Conte C, Ciceri F, et al. Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19. Endocrine 2020;68:475-8.
  • 24. Bossoni S, Chiesa L, Giustina A. Severe hypocalcemia in a thyroidectomized woman with Covid-19 infection. Endocrine 2020;68:253-4.
  • 25. Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem 2020;57:262-5.
  • 26. Cao M, Zhang D, Wang Y, Lu Y, Zhu X, Li Y, al. Clinical features of patients infected with the 2019 novel coronavirus (COVID-19) in Shanghai, China. medRxiv. 2020 Mar; 6. doi: https://doi.org/10.1101/2020.03.04.20030395.
  • 27. Yesiltepe Mutlu G, Hatun S. Use of vitamin D in children and adults: frequently asked questions. J Clin Res Pediatr Endocrinol 2018;10:301-6.
  • 28. Khamis F, Al-Zakwani I, Al Naamani H, Al Lawati S, Pandak N, Omar MB, et al. Clinical characteristics and outcomes of the first 63 adult patients hospitalized with COVID-19: an experience from Oman. J Infect Public Health 2020;13:906-13.
  • 29. Hoechter DJ, Becker-Pennrich A, Langrehr J, Bruegel M, Zwissler B, Schaefer S, et al. Higher procoagulatory potential but lower DIC score in COVID-19 ARDS patients compared to non-COVID-19 ARDS patients. Thromb Res 2020;196:186-92.
  • 30. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
  • 31. Nguyen Y, Corre F, Honsel V, Curac S, Zarrouk V, Fantin B, et al. Applicability of the CURB-65 pneumonia severity score for outpatient treatment of COVID-19. J Infect 2020;81:e96-8.
  • 32. Zhang L, Feng X, Zhang D, Jiang C, Mei H, Wang J, et al. Deep vein thrombosis in hospitalized patients with COVID-19 in Wuhan, China: prevalence, risk Factors, and outcome. Circulation 2020;142:114-28.
  • 33. Rivera-Izquierdo M, Del Carmen Valero-Ubierna M, R-delAmo JL, Fernández-García MÁ, Martínez-Diz S, Tahery-Mahmoud A, et al. Sociodemographic, clinical and laboratory factors on admission associated with COVID-19 mortality in hospitalized patients: a retrospective observational study. PLoS One 2020;15:e0235107.

Details

Primary Language English
Subjects General and Internal Medicine
Journal Section Original Articles
Authors

Iskender EKİNCİ (Primary Author)
Department of Internal Medicine, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
0000-0001-7390-9301
Türkiye


Hanişe ÖZKAN
Department of Internal Medicine, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
0000-0001-6416-0183
Türkiye


Mitat BÜYÜKKABA
Department of Internal Medicine, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
0000-0002-9685-1779
Türkiye


İrem KİRAC UTKU
Department of Internal Medicine, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
0000-0003-3806-5291
Türkiye


Ahmet ÇINAR
Department of Internal Medicine, Arnavutköy State Hospital, İstanbul, Turkey
0000-0002-6949-8025
Türkiye


Ramazan GÜVEN
Department of Emergency Medicine, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
0000-0003-4129-8985
Türkiye


Murat AKARSU
Department of Internal Medicine, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
0000-0002-2675-4252
Türkiye


Abdulbaki KUMBASAR
Department of Internal Medicine, University of Health Sciences, Bakırköy Dr Sadi Konuk Training and Research Hospital, İstanbul, Turkey
0000-0001-7466-9434
Türkiye


Hafize UZUN
Department of Medical Biochemistry, İstanbul University-Cerrahpaşa, School of Cerrahpaşa Medicine, İstanbul, Turkey
0000-0002-1347-8498
Türkiye


Ömür TABAK
Department of Internal Medicine, University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
0000-0001-8848-4561
Türkiye

Publication Date September 4, 2021
Application Date May 21, 2021
Acceptance Date July 26, 2021
Published in Issue Year 2021, Volume 7, Issue 5

Cite

EndNote %0 The European Research Journal The relationship between disease prognosis and serum calcium and corrected calcium levels in COVID-19 patients %A Iskender Ekinci , Hanişe Özkan , Mitat Büyükkaba , İrem Kirac Utku , Ahmet Çınar , Ramazan Güven , Murat Akarsu , Abdulbaki Kumbasar , Hafize Uzun , Ömür Tabak %T The relationship between disease prognosis and serum calcium and corrected calcium levels in COVID-19 patients %D 2021 %J The European Research Journal %P -2149-3189 %V 7 %N 5 %R doi: 10.18621/eurj.940798 %U 10.18621/eurj.940798

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