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COVID-19Research Paper|Volume 12, Issue 12|pp 11287—11295

Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019

Jia-Kui Sun1,5, Wen-Hao Zhang1,5, Lei Zou1,5, Ying Liu1,5, Jing-Jing Li2,5, Xiao-Hua Kan1,5, Lian Dai1,5, Qian-Kun Shi1,5, Shou-Tao Yuan1,5, Wen-Kui Yu3,5, Hong-Yang Xu4,5, Wei Gu1,5, Jian-Wei Qi1,5
  • 1Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China
  • 2Department of Intensive Care Unit, Lishui People's Hospital, Nanjing, Jiangsu Province, China
  • 3Department of Intensive Care Unit, Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
  • 4Department of Intensive Care Unit, Wuxi People's Hospital, Nanjing Medical University, Wuxi, Jiangsu Province, China
  • 5Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Jiangsu Province, China
* Equal contribution
Received: April 6, 2020Accepted: May 30, 2020Published: June 25, 2020

Copyright © 2020 Sun et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The aim of this study was to investigate the correlations between serum calcium and clinical outcomes in patients with coronavirus disease 2019 (COVID-19). In this retrospective study, serum calcium levels, hormone levels and clinical laboratory parameters on admission were recorded. The clinical outcome variables were also recorded. From February 10 to February 28, 2020, 241 patients were enrolled. Of these patients, 180 (74.7%) had hypocalcemia on admission. The median serum calcium levels were 2.12 (IQR, 2.04-2.20) mmol/L, median parathyroid hormone (PTH) levels were 55.27 (IQR, 42.73-73.15) pg/mL, and median 25-hydroxy-vitamin D (VD) levels were 10.20 (IQR, 8.20-12.65) ng/mL. The serum calcium levels were significantly positively correlated with VD levels (P =0.004) but negatively correlated with PTH levels (P =0.048). Patients with lower serum calcium levels (especially ≤2.0 mmol/L) had worse clinical parameters, higher incidences of organ injury and septic shock, and higher 28-day mortality. The areas under the receiver operating characteristic curves of multiple organ dysfunction syndrome, septic shock, and 28-day mortality were 0.923 (P <0.001), 0.905 (P =0.001), and 0.929 (P <0.001), respectively. In conclusion, serum calcium was associated with the clinical severity and prognosis of patients with COVID-19. Hypocalcemia may be associated with imbalanced VD and PTH levels.