Is there any link between Hyperphosphatemia, Hypoalbuminemia, and Hypocalcemia with Hospital Outcomes in COVID‑19 Patients?

Atefeh Rezaeifar, Aliye Tabatabaee, Mansour Siavash, Mojtaba Akbari

Abstract


Background: Disturbed biochemical factors have been observed in viral infections including SARS, Ebola virus, and now COVID‑19. This study aimed to evaluate the association between Calcium axis’ derangements and hospital duration, ICU admission, mechanical ventilation, and death in patients with COVID‑19.

Methods: 428 hospitalized patients with COVID‑19 were included in this study. On the first day of admission, the patients were extensively evaluated for biochemical and hormonal factors and followed up until discharge/death. The association between hyperphosphatemia, hypoalbuminemia, and hypocalcemia and major outcomes, including hospital duration, ICU admission, mechanical ventilation, and death, was investigated by logistic regression analysis.

Results: Hyperphosphatemia and hypoalbuminemia were present in 27 (6.3%) and 59 (13.8%) cases, respectively in the study population. The results of the present study reveal the relation of these factors with worse outcomes in COVID‑19 patients; such as hospital duration, ICU admission, mechanical ventilation, and death. On the other hand, high frequency of hypocalcemia (59.1%, 253 subject) has no significant influence on the mentioned outcomes (All P values were greater than 0.05).

Conclusions: Poor outcomes were associated with hyperphosphatemia and hypoalbuminemia. It seems that we should evaluate the patients for derangements of phosphate, albumin, and calcium and try to treat them for all COVID‑19 patients.


Keywords


COVID‑19; hyperphosphatemia; hypoalbuminemia; hypocalcemia

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References


Uyeki TM, Mehta AK, Davey RT Jr, Liddell AM, Wolf T,

Vetter P, et al. Clinical management of Ebola virus disease in the

United States and Europe. N Engl J Med 2016;374:636‑46.

Booth CM, Matukas LM, Tomlinson GA, Rachlis AR, Rose DB,

Dwosh HA, et al. Clinical features and short‑term outcomes

of 144 patients with SARS in the greater Toronto area. JAMA

;289:2801‑9.

de la Rica R, Borges M, Aranda M, Del Castillo A, Socias A,

Payeras A, et al. Low albumin levels are associated with poorer

outcomes in a case series of COVID‑19 patients in Spain:

A retrospective cohort study. Microorganisms 2020;8:1106. doi:

3390/microorganisms8081106.

Esakandari H, Nabi‑Afjadi M, Fakkari‑Afjadi J,

Farahmandian N, Miresmaeili SM, Bahreini E. A comprehensive

review of COVID‑19 characteristics. Biol Proced Online

;22:1‑10.

Di Filippo L, Formenti AM, Rovere‑Querini P, Carlucci M,

Conte C, Ciceri F, et al. Hypocalcemia is highly prevalent and

predicts hospitalization in patients with COVID‑19. Endocrine

;68:475‑8.

Liu J, Han P, Wu J, Gong J, Tian D. Prevalence and predictive

value of hypocalcemia in severe COVID‑19 patients. J Infect

Public Health 2020;13:1224‑8.

Centers for Disease Control and Prevention. Coronavirus Disease

(COVID‑19) 2020 Interim Case Definition, Approved

April 5, 2020 2020 1/15/2021. Available from: https://wwwn.

cdc.gov/nndss/conditions/coronavirus‑disease‑2019‑covid‑19/

case‑definition/2020/. [Last accessed on 2021 Jan 15].

Bansal VK. Serum inorganic phosphorus In: H.W. Walker HK,

Hurst JW, editors. Clinical Methods: The History, Physical, and

Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990.

Busher JT. Serum albumin and globulin. In: H.W. Walker HK,

Hurst JW, editors. Clinical Methods: The History, Physical, and

Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990.

Goldstein DA. Serum calcium. In: H.W. Walker HK, Hurst JW,

editors. Clinical Methods: The History, Physical, and Laboratory

Examinations. 3rd ed. Boston: Butterworths; 1990.

Akirov A, Masri‑Iraqi H, Atamna A, Shimon I. Low albumin

levels are associated with mortality risk in hospitalized patients.

Am J Med 2017;130:1465.e11‑9.

Huang J, Cheng A, Kumar R, Fang Y, Chen G, Zhu Y,

et al. Hypoalbuminemia predicts the outcome of COVID‑19

independent of age and co‑morbidity. J Med Virol

;92:2152‑8.

Sun JK, Zhang WH, Zou L, Liu Y, Li JJ, Kan XH, et al, Serum

calcium as a biomarker of clinical severity and prognosis in

patients with coronavirus disease 2019. Aging (Albany NY),

;12:11287.

Uribarri A, Núñez-Gil I. J, Aparisi A, Becerra-Muñoz V. M,

Feltes G, Trabattoni D, Impact of renal function on admission

in COVID-19 patients: an analysis of the international HOPE

COVID-19 (Health Outcome Predictive Evaluation for COVID

Registry. Journal of nephrology, 2020;33:737-45.

Kelly A, Levine MA. Hypocalcemia in the critically ill patient.

J Intensive Care Med 2013;28:166‑77.