High prevalence of hypocalcemia in non-severe COVID-19 patients

The novel coronavirus disease (COVID-19) has affected over 50 million people and has inflicted more than 1.2 million casualties ever since its inception in December 2019. Although most patients tend to have mild-moderate disease with a favorable prognosis, the infection may not infrequently lead to severe-to critical disease and mortality¹. The prognosis tends to be poor, specifically in patients with advancing age and in those with co-morbid conditions.² Besides, multiple hematological and biochemical parameters have emerged as potential biomarkers to predict severe disease and mortality in COVID-19.³

One such biochemical biomarker is hypocalcemia. Hypocalcemia is associated with severe disease, organ failure, increased likelihood of hospitalization, admission to the intensive care unit, need for mechanical ventilation in COVID-19.⁴ Nevertheless, hypocalcemia is otherwise common in critically ill patients and is associated with disease severity.⁵ Hence, hypocalcemia in COVID-19 patients with severe or critical disease is not unexpected. However, to date, the prevalence of hypocalcemia in non-severe COVID-19 patients has not been explored. In our clinical practice, we had encountered cases of biochemically confirmed hypocalcemia in patients with non-severe COVID-19.

Hence, the present study was undertaken by Pal et al⁶ to evaluate serum total calcium and phosphate in patients with non-severe COVID- 19 and compare it with age, sex, and serum 25-hydroxyvitamin D level matched healthy adult cohort.

In this retrospective case-control study, medical records of patients (>18 years) diagnosed as non-severe COVID-19 admitted at and discharged from tertiary care institution during the period from April 10, 2020 and June 20, 2020 were retrieved. Baseline investigations, notably, serum calcium, phosphate, albumin, magnesium, 25-hydroxyvitamin D, and C-reactive protein (CRP), were performed at admission before any form of calcium or vitamin D supplementation were considered.

After exclusion, 72 patients with non-severe COVID-19 (63 mild and 9 moderate disease) and an equal number of healthy controls were included in the final analysis. Age, sex, serum 25-hydroxyvitamin D, and albumin levels were matched between the 2 groups. Hypovitaminosis D and hypocalcemia were seen in 97 and 67% of the patients, respectively. The patients had lower serum calcium (P value <0.001) and phosphate (P = 0.007) compared with the controls. There was no statistically significant correlation between serum calcium and CRP.

Study concluded that Hypocalcemia is highly prevalent even in COVID-19 patients with non-severe disease probably implying that hypocalcemia is intrinsic to the disease.

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References:

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6. Pal R, Ram S, Zohmangaihi D, Biswas I, Suri V, Yaddanapudi LN, Malhotra P, Soni SL, Puri GD, Bhalla A and Bhadada SK (2021) High Prevalence of Hypocalcemia in Non-severe COVID-19 Patients: A Retrospective Case-Control Study. Front. Med. 7:590805. doi: 10.3389/fmed.2020.590805