Hypocalcaemia in COVID-19 patients leads to severe illness

Coronavirus disease-2019 (COVID-19) is an acute viral infection of public health importance caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2).¹ The SARS CoV-2 emerged from Wuhan, the largest and capital city of Hubei Province in Central China.¹ The first outbreak was reported as an unexplained pneumonia among persons connected to a seafood market in Wuhan.² It later spread all over China and across the globe. Bats are believed to be the natural reservoir of the virus but some researchers tend to dispute this.³ Transmission is commonly from person to person via respiratory droplets which are released during coughing, sneezing, talking, laughing and singing. However, transmission through contaminated fomites and aerosol, in specific situations, have been documented.⁴ The commonest cause of death in COVID-19 patients is respiratory failure secondary to acute respiratory distress syndrome.⁵

Generally, hypocalcaemia is not an uncommon finding in critically ill patients.⁶ Some of the possible explanations for this include vitamin D deficiency, reduced dietary intake and hypomagnesemia.⁷ Vitamin D deficiency has been documented to be highly prevalent in patients with COVID19.⁸ Studies have also shown that COVID19 patients with hypocalcaemia also tend to have other poor prognostic factors such as lymphopenia, elevated D-dimer, raised C-reactive protein and increased alanine transaminase (ALT).⁶ Patients with hypocalcaemia were found to have higher incidence of acute respiratory distress syndrome (ARDS).⁶ Liu et al.,⁹ also found that hypocalcaemia is also associated with poor outcome in patients with COVID-19.

Systematic review of studies reported the prevalence and prognostic implications of hypocalcaemia in COVID19 patients by Azeez et al.¹⁰ This review aims to estimate the prevalence of hypocalcaemia among COVID-19 patients and identify the poor prognostic factors associated with the presence of hypocalcaemia in COVID-19 patients. Electronic medical databases were searched for publications on the prognostic implications of hypocalcaemia in COVID-19 infection, and relevant articles were selected for systematic review following PRISMA algorithm. The prevalence of hypocalcaemia among patients with COVID-19 was 40.0-74.4%. There was a significant association between the rate of hospital admission, intensive care unit (ICU) admission as well as septic shock and hypocalcaemia in patients with COVID-19. COVID-19 patients with hypocalcaemia tend to have elevated C-reactive protein, interleukin6, alanine transaminase, procalcitonin, serum creatinine and low albumin. Hypocalcaemia is common in COVID-19 patients and is a poor prognostic factor in these patients. Presence of hypocalcaemia is associated with a severe illness.

Feel free to reach us for queries admin(at)youngatbones.com

Connect with us on:

facebook – twitter – LinkedIn – Instagram

References

1. Shereen, M. A., Khan, S., Kazmi, A., Bashir, N., and Siddique, R. COVID-19 infection: origin, transmission and characteristics of human coronaviruses. J Adv Res. 2020; 24: 91-98.
2. Wu, Y. C., Chen, C. S., and Chan, Y. J. The outbreak of COVID-19: an overview. J Chin Med Assoc. 2020; 83 (3): 217-220.
3. Zhu, N., Zhang, D., Wang, W., et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382 (8): 727-733.
4. Brewster, D. J., Chrimes, N. C., Do, T. B.T., et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID‐19 adult patient group. Med J Aust. 2020; 212: 472–481.
5. Ruan, Q., Yang, K., Wang, W., et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020; 46 (5): 846-848.
6. Sun, J. K., Zhang, W. H., Zou, L., et al. Serum calcium as a marker of clinical severity and prognosis in patients coronavirus disease 2019. Aging (Albany NY). 2020; 12 (12): 11287-11295.
7. Kelly, A., and Levine, M. A. Hypocalcemia in the critically ill patient. J Intensive Care Med. 2013; 28 (3):166-177.
8. Azeez, T. Vitamin D deficiency and COVID-19: A review on the combined challenges of the olderadults in low resource settings. J Pharmacovigil. 2020; 8 (3): 281.
9. Liu, J., Han, P., Wu, Y., Gong, J., and Tian, D. Prevalence and predictive value of hypocalcaemia in severe COVID-19 patients. J Infect Publ Hlth. 2020; 13 (9): 1224-1228.
10. Azeez, T. A., Lakoh, S., Bamidele, O. T., Ekhaiyeme, E., and Nwosu, S. A. Prognostic implication of hypocalcaemia in COVID-19: a systematic review. Afr. J. Clin. Exper. Microbiol. 2021; 22 (2): 124 – 132