Severity of COVID-19: Correlation with Serum Calcium levels

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV- 2) is a newly emerging zoonotic corona virus that was discovered in Wuhan, China in December 2019 and has been identified as Coronavirus Disease 2019 (COVID-19).(1)

The virus’s main manifestations on patients include fever, cough and shortness of breath that can progress rapidly in some cases to severe pneumonia, acute respiratory distress syndrome (ARDS) and septic shock.(2)

The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) as a public health emergency of grave international concern.(3)

Although the clinical picture of SARS, MERS, and COVID-19 seems to be similar, differences were noted since early reports at the beginning of the pandemic. Hence a proper characterization of the full pathophysiology of this disease, clinical progression, possible sequalae, are critical to battle the detrimental effects of this disease.

Patients admitted into intensive care unit (ICU) had more severe clinical symptoms and more abnormal serum parameters.(4) Throughout this pandemic, there has been a panoply of biochemical parameters suggested in literature that have been found to be inextricably linked to clinical progression of patients in different populations.(5)

There have been a few published studies regarding the significance of calcium levels as a predictor of severity of disease, amongst other biomarkers like D-Dimer, CRP, and Ferritin.(1)

Osman et al conducted a study aims to investigate this link in population of COVID patients as well, namely corrected calcium to the progression of patients through a particular set of parameters biochemical and clinical.(1) This was Observational cohort study in adults admitted with COVID-19 from March till September 2020. Around 445 patients were included in the study. Results shown that hypocalcemic patients had more abnormal laboratory parameters and longer hospitalization duration. Hypocalcemia was in 60-75% of all age groups (p-value 0.053), for which 77.97% were ICU admissions (p-value 0.001) and 67.02% were diabetic (p-value 0.347). There were non-significant correlations between Vitamin D and almost all the parameters except for chronic respiratory diseases with P value of 0.024.(1)

Data suggests, particularly from the multivariate analysis, hypocalcemia is a very reliable marker for disease progression as a predictor and as part of the overall symptomatology of the disease. The worse the hypocalcemia, the more severe the clinical progression of the patients with complications.(1) Vitamin D levels fail to reflect correlation with severity of COVID-19 infections.

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References:

1. Osman W, Al Fahdi F, Khamis F, Salmi IA, Khalili HA, Gokhale A, Serum Calcium and Vitamin D levels correlation with severity of COVID-19 in hospitalized patients in Royal Hospital, Oman. Int J Infect Dis. 2021 Apr 20; S1201-9712(21)00361-1.
2. 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. https://doi.org/10.1016/j.jiph.2020.06.002.
3. KEŠEĽOVÁ M, ŠVÁB P, KORBA P, HOVANEC M. The impact of the covid-19 outbreak on aviation. Sci Pap Silesian Univ Technol – Organ Manag Ser 2020;2020:253–62. https://doi.org/10.29119/1641-3466.2020.148.19.
4. 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. https://doi.org/10.1016/S0140-6736(20)30183-5.
5. di Filippo L, Formenti AM, Giustina A. Hypocalcemia: the quest for the cause of a major
biochemical feature of COVID-19. Endocrine 2020; 70:463–4. https://doi.org/10.1007/s12020-020-02525-9.