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Research
Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019: a retrospective cross-sectional study
Qian-Kun Shi
Nanjing First Hospital
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: To investigate the correlations between serum calcium and clinical severity and outcomes in patients with coronavirus disease 2019 (COVID-19).
Methods: In this clinical retrospective study, the levels of serum calcium, hormone levels and clinical laboratory parameters of admission were recorded. The clinical severity and outcome variables were also recorded.
Results: From February 10 to February 28 2020, 241 patients were enrolled in this study. 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, median 25-hydroxy-vitamin D (VD) levels were 10.20 (IQR, 8.20-12.65) ng/mL. The serum calcium levels were significantly positive correlated with VD levels (P =0.004), whereas negative correlated with PTH levels (P = 0.048). Patients with lower serum calcium levels (especially ≤2.0 mmol/L) had worse clinical parameters, higher incidence of organ injury 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. The overall mortality of COVID-19 was 4.1% (10/241), whereas the mortality of critical patients was up to 40.0% (10/25).
Conclusions: Serum calcium was associated with clinical severity and prognosis of patients with COVID-19. Hypocalcemia may be associated with imbalanced VD and PTH.
Keywords
Hypocalcemia, Vitamin D, Parathyroid hormone, Organ injury, Prognosis, COVID-19
Figure 1
Figure 2
Figure 3
Nina Roller
commented on 07 June, 2020
I know this is true. I was sick in early February. My symptoms: Extreme chest discomfort and aches, trouble breathing (That lasted each of the 5 days), by day 3, I began having intermittent diarrhea and later that evening a blister like rash appeared on my leg and arm, by day five I woke up feeling better and by lunch time I went downhill, Then over about 90 minutes I started experiencing tingling of hands, then feet, then lips, then head. Began experiencing extreme lightheadedness. Called my doc the nurse told me to go to ER. After being discharged, I decided to review my labs and the blood work indicated my calcium levels dropped almost an entire point. I went home and drank (slammed) two large glasses of milk Immediately. Within 45 minutes my Raspy voice Was back to my normal voice. I followed up with 2000 mg of Tums each night for about 9 days. I have sent information to doctors and scientists around the world hoping someone may take this more seriously. The milk I drank gave me more positive results than that of a steroid treatment and a breathing treatment- hands down. The chest pain was 95% gone at the 45 minute marks as well. Please reach out to me if you would like me to provide you with any of my tests. I believe, for those suffering from chest and/or breathing issues, they should immediately have their calcium levels looked at within the first week of onset. I sincerely think that based on my symptoms, had I not decided to look over my blood results that evening, I would have needed to be checked within the next few day’s. Thank you and God bless. Kindest Regards, Nina
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Research
Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019: a retrospective cross-sectional study
Qian-Kun Shi
Nanjing First Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 18 Mar, 2020
Community comments: 4
Metrics
Comments: 4
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: To investigate the correlations between serum calcium and clinical severity and outcomes in patients with coronavirus disease 2019 (COVID-19).
Methods: In this clinical retrospective study, the levels of serum calcium, hormone levels and clinical laboratory parameters of admission were recorded. The clinical severity and outcome variables were also recorded.
Results: From February 10 to February 28 2020, 241 patients were enrolled in this study. 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, median 25-hydroxy-vitamin D (VD) levels were 10.20 (IQR, 8.20-12.65) ng/mL. The serum calcium levels were significantly positive correlated with VD levels (P =0.004), whereas negative correlated with PTH levels (P = 0.048). Patients with lower serum calcium levels (especially ≤2.0 mmol/L) had worse clinical parameters, higher incidence of organ injury 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. The overall mortality of COVID-19 was 4.1% (10/241), whereas the mortality of critical patients was up to 40.0% (10/25).
Conclusions: Serum calcium was associated with clinical severity and prognosis of patients with COVID-19. Hypocalcemia may be associated with imbalanced VD and PTH.
Figure 1
Figure 2
Figure 3
Nina Roller
commented on 07 June, 2020
I know this is true. I was sick in early February. My symptoms: Extreme chest discomfort and aches, trouble breathing (That lasted each of the 5 days), by day 3, I began having intermittent diarrhea and later that evening a blister like rash appeared on my leg and arm, by day five I woke up feeling better and by lunch time I went downhill, Then over about 90 minutes I started experiencing tingling of hands, then feet, then lips, then head. Began experiencing extreme lightheadedness. Called my doc the nurse told me to go to ER. After being discharged, I decided to review my labs and the blood work indicated my calcium levels dropped almost an entire point. I went home and drank (slammed) two large glasses of milk Immediately. Within 45 minutes my Raspy voice Was back to my normal voice. I followed up with 2000 mg of Tums each night for about 9 days. I have sent information to doctors and scientists around the world hoping someone may take this more seriously. The milk I drank gave me more positive results than that of a steroid treatment and a breathing treatment- hands down. The chest pain was 95% gone at the 45 minute marks as well. Please reach out to me if you would like me to provide you with any of my tests. I believe, for those suffering from chest and/or breathing issues, they should immediately have their calcium levels looked at within the first week of onset. I sincerely think that based on my symptoms, had I not decided to look over my blood results that evening, I would have needed to be checked within the next few day’s. Thank you and God bless. Kindest Regards, Nina
View 1 reply
NB
replied on 20 June, 2020
Thanks for your feedback. So to understand your calcium levels were high with Covid?
View 1 reply
Nina
replied on 22 June, 2020
Hi, No, my calcium level decreased. The chest discomfort and Labored breathing I was experiencing had resolved by 90% within 45 minutes of drinking the milk. It was unbelievable, even my voice went from “bronchitis” like to completely normal. For precautionary effort, I followed up with the Tums. My blood work at my follow up appointment showed my calcium levels were back to my normal range. Drinking the milk literally had the same effect of receiving a breathing treatment and receiving steroid treatment. The difference was the milk took only 45 minutes for me to be able to breathe normal after five days of labored breathing from the illness.
View 1 reply
Nina
replied on 23 June, 2020
Just clarify, I believe the illness caused my calcium levels to drop very fast. The rapid drop of calcium causing bronchial constriction. If a person has bronchial construction, lung capacity may be compromised eventually turning into pneumonia. Based on another study I read about the virus causing an influx of calcium- thus influx of calcium may first be pulled from bronchi and then lung tissues, then eventually leading to and effecting the surrounding tissues/organs. For an example: This drop in calcium may possibly contribute to the inability to smell some people are experiencing. The lack of calcium in the tissues of that area may hinder the olfactory signaling.
NB
replied on 20 June, 2020
Thanks for your feedback. So to understand your calcium levels were high with Covid?
View 1 reply
Nina
replied on 22 June, 2020
Hi, No, my calcium level decreased. The chest discomfort and Labored breathing I was experiencing had resolved by 90% within 45 minutes of drinking the milk. It was unbelievable, even my voice went from “bronchitis” like to completely normal. For precautionary effort, I followed up with the Tums. My blood work at my follow up appointment showed my calcium levels were back to my normal range. Drinking the milk literally had the same effect of receiving a breathing treatment and receiving steroid treatment. The difference was the milk took only 45 minutes for me to be able to breathe normal after five days of labored breathing from the illness.
View 1 reply
Nina
replied on 23 June, 2020
Just clarify, I believe the illness caused my calcium levels to drop very fast. The rapid drop of calcium causing bronchial constriction. If a person has bronchial construction, lung capacity may be compromised eventually turning into pneumonia. Based on another study I read about the virus causing an influx of calcium- thus influx of calcium may first be pulled from bronchi and then lung tissues, then eventually leading to and effecting the surrounding tissues/organs. For an example: This drop in calcium may possibly contribute to the inability to smell some people are experiencing. The lack of calcium in the tissues of that area may hinder the olfactory signaling.