Evaluation of the correlation of serum calcium, phosphorus levels and calcium phosphorus product with disease severity and ICU mortality in SARS-COV-2 pneumonia patients followed up in ICU

Year 2022, Volume: 5 Issue: 5, 1232 - 1237, 25.09.2022

Derya Hoşgün , Semih Aydemir

https://doi.org/10.32322/jhsm.1120563

Abstract

Background: Calcium and phosphorus are important elements in the body that have been shown to decrease in critical inflammatory diseases. The aim of this study was to evaluate serum levels of calcium and phosphorus and the calcium phosphate product (CPP) in patients followed up in intensive care unit (ICU) due to hypoxemic respiratory failure caused by coronavirus disease 2019 (COVID-19) pneumonia. The secondary endpoint of the study were respiratory support therapies used in the evaluation of independent mortality and disease severity in ICU that were divided into four groups depending on the time of administration: (i) first 24 hours, (ii) 48-72 hours, (iii) 72 hours, and (iv) 72 hours-28 days.
Material and Method: The retrospective study included patients with critical and severe COVID-19 pneumonia followed up in ICU.
Results: The study included 369 patients with a mean age of 64.3±14.8 years. ICU mortality was observed in 142 (38.5%) patients, among whom 17 (4.6%) patients died within 24 hours, 28 (7.6%) died between 48-72 hours, 50 (12.7%) died within 72 hours, and 47 (12.7%) died between 72 hours and 28 days. Serum calcium level established a significant relationship with ICU mortality at 28 days and 72 hours (p<0.05). Serum phosphorus and calcium levels were not found as significant predictors of CPP (p>0.05).
Conclusion: Serial assessment of serum calcium may be a new criterion in the prediction of independent mortality in critical and severe COVID-19 pneumonia, which has been recently identified and has numerous unknown features.

Keywords

Mortality, calcium, phosphorus

Project Number

YOK

References

• Chu KH, Tsang WK, Tang CS, et al. Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int 2005; 67: 698-5.
• Pan XW, Xu D, Zhang H, Zhou W, Wang LH, Cui XG. Identification of potential mechanism of acute kidney injury during the COVİD-19 outbreak: a study based on single-cell transcriptome analysis.Intensive Care Med 2020; 46: 1114-6.
• Lim AYH, Goh JL, Chua MCW, Heng BH, Abisheganaden JA, George PP. Temporal changes of haematological and radiological findings of the COVID-19 infection-a review of literature. BMC Pulm Med 2021; 21: 37.
• Aguilera IM, Vaughan RS. Calcium and the anaesthetist. Anaesthesia 2000; 55: 779-90.
• Cappellini F, Brivio R, Casati M, Cavallero A, Contro E, Brambilla P. Low levels of total and ionized calcium in blood of COVID-19 patients. Clin Chem Lab Med 2020; 58: e171-3.
• Zhou X, Chen D, Wang L, et al. Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical. Biosci Rep 2020; 40: BSR20202690.
• Bugg NC, Jones JA. Hypophosphataemia: pathophysiologyd, effects and management on the intensive care unit. Anaesthesia 1998; 53: 895-2.
• Shor R, Halabe A, Rishver S, et al. Severe hypophosphatemia in sepsis as a mortality predictor. Ann Clin Lab Sci 2006; 36: 67-2.
• Yang C, Ma X, Wu J, et al. Low serum calcium and phosphorus and their clinical performance in detecting COVID-19 patients. J Med Virol 2021; 93: 1639-51.
• Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44: S27-72.
• James MT, Zhang J, Lyon AW, Hemmelgarn BR. Derivation and internal validation of an equation for albumin-adjusted calcium. BMC Clin Pathol 2008; 8: 12.
• Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med 2011; 39: 163-9.
• van Kempen TATG, Deixler E. SARS-CoV-2: influence of phosphate and magnesium, moderated by vitamin D, on energy (ATP) metabolism and on severity of COVID-19. Am J Physiol Endocrinol Metab 2021; 320: E2-6.
• Sun JK, Zhang WH, Zou L, et al. Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019. Aging (Albany NY) 2020; 12: 11287-95.
• Dai Q, Zhu X, Manson J.E, Song Y, Li X, Franke AA. Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial. Am J Clin Nutr 2018; 108: 1258–69.
• Lippi G, South AM, Henry BM. Electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem 2020; 57: 262-5.
• Quraishi SA, Bittner EA, Christopher KB, Camargo CA. Vitamin D status and community-acguired pneumonia: results from the third national health and nutrition examination survey. PLoS One 2013; 8: e81120.
• Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013; 28: 16677.
• Torres B, Alcubilla P, Cordon-Gonzalez A, et al. Impact of low serum calcium at hospital admission on SARS-CoV-2 infection outcome. Int J Infect Diseases 2021; 164-8.
• Zhang Z, Chen K, Ni H. Calcium supplementation improves clinical outcome in intensive care unit patients: a propensity score matched analysis of a large clinical database MIMIC-II. Springerplus 2015; 4: 594.
• Block GA, Hulbert-Shearon TE, Levin NW, Port FK. Association of serum phosphorus and calcium x phosphorus product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998; 31: 607-17.