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Hypocalcemia is associated with severe COVID-19: A systematic review and meta-analysis
Januar Wibawa Martha1, Arief Wibowo1, Raymond Pranata2
1Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjadjaran, Rumah Sakit Umum Pusat Hasan Sadikin, Bandung, Indonesia.
Insights
Hypocalcemia, or low calcium levels, is linked to worse outcomes in COVID-19 patients. This condition was associated with a higher likelihood of mortality and severity in coronavirus disease 2019.
Area of Science:
- Critical care medicine
- Infectious diseases
- Clinical biochemistry
Background:
- Hypocalcemia is a frequent complication in critically ill patients.
- Studies indicate a high prevalence of hypocalcemia in patients diagnosed with COVID-19.
Purpose of the Study:
- To conduct a meta-analysis evaluating the prognostic significance of hypocalcemia in patients with COVID-19.
- To assess the association between hypocalcemia and poor outcomes in COVID-19 patients.
Main Methods:
- Systematic literature search of PubMed, Scopus, and Embase for studies on "SARS-CoV-2" or "COVID-19" and "hypocalcemia" up to December 10, 2020.
- Defined hypocalcemia as serum calcium below study-specific cut-off points.
- Analyzed poor outcome (mortality and severity composite) using odds ratios (OR), confidence intervals (CI), sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and area under the curve (AUC).
Main Results:
- Included 2032 patients from 7 studies; 26% experienced poor outcomes.
- Serum calcium levels were significantly lower in patients with poor outcomes (mean difference -0.173 mmol/L).
- Hypocalcemia was significantly associated with poor outcomes (OR 3.19; 95% CI [2.02, 5.06]), with an AUC of 0.70.
- Post-test probability of poor outcome was 36% in patients with hypocalcemia versus 15% in those without.
Conclusions:
- Hypocalcemia is a significant prognostic indicator in COVID-19 patients.
- The presence of hypocalcemia is associated with an increased likelihood of poor outcomes, including mortality and disease severity.
Background And Aims:
Hypocalcemia is commonly in critically ill patients and studies have shown that hypocalcemia is prevalent in patients with COVID-19. This meta-analysis aimed to evaluate the prognostic performance of hypocalcemia in patients with coronavirus disease 2019 (COVID-19).
Methods:
We performed a systematic literature search on PubMed, Scopus, and Embase with keywords "SARS-CoV-2″ OR″COVID-19″ OR ″2019-nCoV" AND "hypocalcemia" up until 10 December 2020. The key exposure was hypocalcemia, defined as serum calcium below study-defined cut-off points. The main outcome was poor outcome, which was a composite of mortality and severity. The effect estimate of the main outcome was reported as odds ratio (OR) and its 95% confidence interval (95% CI). We also generate sensitivity, specificity, positive and negative likelihood ratio (PLR & NLR), diagnostic odds ratio (DOR), and area under curve (AUC).
Results:
There are 2032 patients from 7 studies included in this systematic review and meta-analysis. The incidence of poor outcome in this study was 26%. Serum calcium was lower in patients with poor outcome (mean difference -0.173 mmol/L [-0.259, -0.087], p < 0.001; I2: 31.3%). Hypocalcemia was associated with poor outcome (OR 3.19 [2.02, 5.06], p < 0.001; I2: 32.86%); with sensitivity of 0.74 [0.53, 0.88], specificity of 0.54 [0.29, 0.77], PLR of 1.6 [1.1, 2.3], NLR of 0.49 [0.35, 0.66], DOR of 3 [2, 5], and AUC of 0.70 [0.66, 0.74]. In this pooled analysis, the post-test probability was 36% in patients with hypocalcemia and 15% in patients without hypocalcemia.
Conclusion:
Hypocalcemia was associated with poor outcome in COVID-19 patients.
Prospero Id:
CRD42020225506.
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