Correlation of hypocalcemia with poor prognosis of COVID-19 based on COX regression model: an analysis of 2 651 patients

Hedong XIANG; Chuan LIU; Jingbin KE; Hu TAN; Limin ZHANG; Xiaohan DING; Ping LI; Xubin GAO; Jie YANG; Lan HUANG

doi:10.16016/j.1000-5404.202011151

您当前的位置：

首页 >

文章列表页 >

Correlation of hypocalcemia with poor prognosis of COVID-19 based on COX regression model: an analysis of 2 651 patients

Clinical Medicine | 更新时间：2026-01-09

- Correlation of hypocalcemia with poor prognosis of COVID-19 based on COX regression model: an analysis of 2 651 patients
- Journal of Third Military Medical University Vol. 43, Issue 8, Pages: 722-729(2021)
- 作者机构：
  
  400037 重庆，陆军军医大学(第三军医大学)第二附属医院心血管内科，全军心血管病研究所
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.202011151
  CLC： R511;R563.107;R591.1
- Received：17 November 2020，
  
  Revised：2021-02-08，
  
  Published：30 April 2021
- 稿件说明：
移动端阅览
Hedong XIANG, Chuan LIU, Jingbin KE, et al. Correlation of hypocalcemia with poor prognosis of COVID-19 based on COX regression model: an analysis of 2 651 patients[J]. Journal of Third Military Medical University, 2021, 43(8): 722-729.
DOI：

Hedong XIANG, Chuan LIU, Jingbin KE, et al. Correlation of hypocalcemia with poor prognosis of COVID-19 based on COX regression model: an analysis of 2 651 patients[J]. Journal of Third Military Medical University, 2021, 43(8): 722-729. DOI： 10.16016/j.1000-5404.202011151.

摘要

目的

探讨低血钙与COVID-19患者预后不良的关系。

方法

回顾性分析2020年2月4日至4月11日在武汉火神山医院就诊的2 651例COVID-19患者资料，对比分析低血钙组患者(

=773)与正常血钙组患者(

=1 878)的人口学基本特征、实验室检查、治疗、并发症和预后结果，采用Cox回归模型分析低血钙是否为COVID-19患者预后不良的独立危险因素。

结果

与正常血钙组比较，低血钙组患者机械通气使用率、体外膜肺氧合使用率和重症监护室入住率显著升高(

0.05)，脓毒血症、休克、急性呼吸窘迫综合征、呼吸衰竭、低蛋白血症、急性心肌损伤、急性肾脏损伤、凝血障碍发生率和死亡率也显著增加(

0.05)，住院时间显著延长(

0.001)；轻型及普通型、重型、危重型COVID-19患者中血钙水平分别为2.17 (2.11，2.24)、2.13 (2.04，2.21)、2.03 (1.89，2.18) mmol/L，不同类型间患者血钙差异有统计学意义(

0.05)，并且随着COVID-19的临床类型加重血钙值越低(

0.05)，死亡患者血钙值显著低于非死亡患者[1.97 (1.87

2.03)

2.17 (2.09

2.23) mmol/L，

0.001

]

；多元Cox回归模型分析显示，血钙

2.11 mmol/L是COVID-19患者预后不良的独立危险因素(

=5.695，95%

：2.363~13.725，

0.001)。

结论

低血钙是影响COVID-19患者预后不良的独立危险因素，纠正低血钙可能是改善COVID-19患者预后的重要策略。

Abstract

Objective

To investigate whether hypocalcemia is associated with poor prognosis in COVID-19 patients.

Methods

A retrospective analysis was performed on 2 651 COVID-19 patients admitted to Wuhan Huoshenshan Hospital from February 4

2020 to April 11

2020. They were divided into low and normal calcium groups according to their serum calcium level lower than 2.11 mmol/L or not. Their basic demographic characteristics

results of laboratory tests

treatment

complications and outcomes were analyzed and compared between the 2 groups. COX regression model was used to analyze whether low calcium is an independent risk factors for poor outcomes in COVID-19 patients.

Results

The low calcium group had significantly higher ratios of mechanical ventilation

extracorporeal membrane oxygenation (ECMO) and ICU occupancy (

0.05); obviously higher incidences of sepsis

shock

hypoproteinemia

respiratory failure

coagulation disorders

acute kidney injury

acute myocardial injury

acute respiratory distress syndrome (ARDS)

and even mortality (

0.05); and remarkably longer length of hospital stay (

0.001) when compared with the normal calcium group. The blood calcium level of mild and common

severe

and critical COVID-19 patients was 2.17 (2.11

2.24)

2.13 (2.04

2.21)

and 2.03 (1.89

2.18) mmol/L

respectively

and significant differences were seen among the patients (

0.05). The calcium level was in a decreasing trend with the severity of COVID-19 (

0.05). The calcium level was statistically lower in the dead patients than those survival [1.97 (1.87

2.03)

2.17 (2.09

2.23)

0.001

]

. Multivariate Cox regression analysis indicated that serum calcium concentration

2.11 mmol/L was an independent risk factor for poor prognosis of COVID-19 (

=5.695

95%

: 2.363~13.725

0.001).

Conclusion

Low blood calcium level is an independent risk factor for poor prognosis in COVID-19 patients. Correction for hypocalcemia may be an important strategy to improve the prognosis of COVID-19 patients.

关键词

Keywords

references

HUANG C, WANG Y, LI X, et al . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J ] . Lancet, 2020, 395(10223): 497-506. DOI: 10.1016/S0140-6736(20)30183-5.

CHEN N, ZHOU M, DONG X, et al . Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J ] . Lancet, 2020, 395(10223): 507-513. DOI: 10.1016/S0140-6736(20)30211-7.

CHEUNGPASITPORN W, THONGPRAYOON C, MAO M A, et al . Impact of admission serum calcium levels on mortality in hospita lized patients[J ] . Endocr Res, 2018, 43(2): 116-123. DOI: 10.1080/07435800.2018.1433200.

MILLET J K, WHITTAKER G R. Physiological and molecular triggers for SARS-CoV membrane fusion and entry into host cells[J]. Virology, 2018, 517: 3-8. DOI: 10.1016/j.virol.2017.12.015.

[WHO. Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected: interim guidance[EB/OL ] . [2020-09-25 ] . https://apps.who.int/iris/handle/10665/330854 https://apps.who.int/iris/handle/10665/330854 .

李想, 白万富, 周红兵. 新型冠状病毒肺炎治疗策略[J]. 包头医学院学报, 2020, 36(3): 118-123. DOI: 10.16833/j.cnki.jbmc.2020.03.043.

LI X, BAI W F, ZHOU H B. Treatment strategy of COVID-19[J]. Baotou Med College J, 2020, 36 (3) : 118-123. DOI: 10.16833/j.cnki.jbmc.2020.03.043.j.carol carroll nki JBMC. 2020.03.043.

JHA V, ARICI M, COLLINS A J, et al . Understanding kidney care needs and implementation strategies in low-and middle-income countries: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference[J ] . Kidney Int, 2016, 90(6): 1164-1174. DOI: 10.1016/j.kint.2016.09.009.

LALA A, JOHNSON K W, JANUZZI J L, et al . Prevalence and impact of myocardial injury in patients hospitalized with COVID-19 infection[J ] . J Am Coll Cardiol, 2020, 76(5): 533-546. DOI: 10.1016/j.jacc.2020.06.007.

FORCE A D T, RANIERI V M, RUBENFELD G D, et al . Acute respiratory distress syndrome: the Berlin Definition[J ] . JAMA, 2012, 307(23): 2526-2533. DOI: 10.1001/jama.2012.5669.

BILINSKI A, EMANUEL E J. COVID-19 and excess all-cause mortality in the US and 18 comparison countries[J]. JAMA, 2020, 324(20): 2100-2102. DOI: 10.1001/jama.2020.20717.

BUDHATHOKI P, SHRESTHA D B, RAWAL E, et al . Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis[J ] . SN Compr Clin Med, 2020: 1-21. DOI: 10.1007/s42399-020-00515-6.

SCHUTTE A E, HARRISON D G. Immunity, inflammation and the vasculature in the COVID-19 era[J]. J Hypertens, 2020, 38(9): 1701-1702. DOI: 10.1097/HJH.0000000 000002525.

DE LA RICA R, BORGES M, GONZALEZ-FREIRE M. COVID-19: in the eye of the cytokine storm[J]. Front Immunol, 2020, 11: 558898. DOI: 10.3389/fimmu.2020.558898.

JAFARZADEH A, CHAUHAN P, SAHA B, et al . Contribution of monocytes and macrophages to the local tissue inflammation and cytokine storm in COVID-19: Lessons from SARS and MERS, and potential therapeutic interventions[J ] . Life Sci, 2020, 257: 118102. DOI: 10.1016/j.lfs.2020.118102.

YOUNAN P, IAMPIETRO M, NISHIDA A, et al . Ebola virus binding to Tim-1 on T lymphocytes induces a cytokine storm[J ] . mBio, 2017, 8(5): 2586. DOI: 10.1128/mBio.00845-17.

HUSSAIN F S, ELDEEB M A, BLACKMORE D, et al . Guillain Barre syndrome and COVID-19: Possible role of the cytokine storm[J ] . Autoimmun Rev, 2020, 19(12): 102681. DOI: 10.1016/j.autrev.2020.102681.

ASBAGHI O, SADEGHIAN M, MOZAFFARI-KHOSRAVI H, et al . The effect of vitamin d-calcium co-supplementation on inflammatory biomarkers: A systematic review and meta-analysis of randomized controlled trials[J ] . Cytokine, 2020, 129: 155050. DOI: 10.1016/j.cyto.2020.155050.

KLEIN G L. The role of calcium in inflammation-associated bone resorption[J]. Biomolecules, 2018, 8(3): 69. DOI: 10.3390/biom8030069.

DI FILIPPO L, FORMENTI A M, DOGA M, et al . Hypocalcemia is a distinctive biochemical feature of hospitalized COVID-19 patients[J ] . Endocrine, 2021, 71(1): 9-13. DOI: 10.1007/s12020-020-02541-9.

BOOTH C M, MATUKAS L M, TOMLINSON G A, et al . Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area[J ] . JAMA, 2003, 289(21): 2801-2809. DOI: 10.1001/jama.289.21.JOC30885.

LIU J, HUANG Q, YANG M, et al . Risk factors predicting severe hypocalcemia after total parathyroidectomy without autotransplantation in patients with secondary hyperparathyroidism[J ] . J Int Med Res, 2020, 48(1): 300060519897505. DOI: 10.1177/0300060519897505.

AMIRJAMSHIDI A. Hypocalcemia as a prognostic factor in mortality and morbidity in moderate and severe traumatic brain injury[J]. Asian J Neurosurg, 2015, 10(3): 138.

SUN X, ZHANG X, LU, Y, et al . Risk factors for severe hypocalcemia after parathyroidectomy in dialysis patients with secondary hyperparathyroidism[J ] . Sci Rep, 2018, 8(1): 7743. DOI: 10.1038/s41598-018-26142-9.

CHISTHI M M, NAIR R S, KUTTANCHETTIYAR K G, et al . Mechanisms behind post-thyroidectomy hypocalcemia: interplay of calcitonin, parathormone, and albumin—a prospective study[J ] . J Invest Surg, 2017, 30(4): 217-225. DOI: 10.1080/08941939.2016.1235238.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Prognostic factors of sudden hearing loss

A novel estrogen receptor expression stratification (low/moderate/high) based on Chinese population provides more accurate prognosis prediction for HR⁺/HER2^- early breast cancer patients

Immunosuppressive microenvironment of TGIF1-overexpressing gastric cancers and its clinical significance

Related Author

陈黎黎

江黎珠

胡国华

陈鸿雁

WU Zhenzhen

CAO Tingyong

FENG Youfan

ZHAO Li

Related Institution

The First Clinical Medical College， Lanzhou University

Department of Hematology， the Second Hospital & Clinical Medical School， Lanzhou University

Department of Hematology， Gansu Provincial Hospital

Gansu Provincial Clinical Medical Research Center for Molecular Diagnosis and Treatment of Hematological Diseases， the First Hospital， Lanzhou University

The Laboratory Center， the First Hospital， Lanzhou University

⁰