Hypocalcemia in COVID-19: Prevalence, clinical significance and therapeutic implications
Top Cited Papers
- 13 April 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Reviews in Endocrine and Metabolic Disorders
- Vol. 23 (2), 299-308
- https://doi.org/10.1007/s11154-021-09655-z
Abstract
COVID-19 extra-pulmonary features include several endocrine manifestations and these are becoming strongly clinically relevant in patients affected influencing disease severity and outcomes. At the beginning of COVID-19 pandemic no population data on calcium levels in patients affected were available and in April 2020 a first case of severe acute hypocalcemia in an Italian patient with SARS-CoV-2 infection was reported. Subsequently, several studies reported hypocalcemia as a highly prevalent biochemical abnormality in COVID-19 patients with a marked negative influence on disease severity, biochemical inflammation and thrombotic markers, and mortality. Also a high prevalence of vertebral fractures with worse respiratory impairment in patients affected and a widespread vitamin D deficiency have been frequently observed, suggesting an emerging “Osteo-Metabolic Phenotype” in COVID-19. To date, several potential pathophysiological factors have been hypothesized to play a role in determining hypocalcemia in COVID-19 including calcium dependent viral mechanisms of action, high prevalence of hypovitaminosis D in general population, chronic and acute malnutrition during critical illness and high levels of unbound and unsaturated fatty acids in inflammatory responses. Since hypocalcemia is a frequent biochemical finding in hospitalized COVID-19 patients possibly predicting worse outcomes and leading to acute cardiovascular and neurological complications if severe, it is reasonable to assess, monitor and, if indicated, replace calcium at first patient hospital evaluation and during hospitalization.Keywords
This publication has 100 references indexed in Scilit:
- Lipolysis of Visceral Adipocyte Triglyceride by Pancreatic Lipases Converts Mild Acute Pancreatitis to Severe Pancreatitis Independent of Necrosis and InflammationThe American Journal of Pathology, 2015
- Rubella Virus: First Calcium-Requiring Viral Fusion ProteinPLoS Pathogens, 2014
- The clinically approved drugs amiodarone, dronedarone and verapamil inhibit filovirus cell entryJournal of Antimicrobial Chemotherapy, 2014
- Viral calciomics: Interplays between Ca2+ and virusCell Calcium, 2009
- Vitamin D for Treatment and Prevention of Infectious Diseases; A Systematic Review of Randomized Controlled TrialsEndocrine Practice, 2009
- Amiodarone Alters Late Endosomes and Inhibits SARS Coronavirus Infection at a Post-Endosomal LevelAmerican Journal of Respiratory Cell and Molecular Biology, 2008
- Calcium signalling: dynamics, homeostasis and remodellingNature Reviews Molecular Cell Biology, 2003
- Clinical Features and Short-term Outcomes of 144 Patients With SARS in the Greater Toronto AreaJAMA, 2003
- Interaction of the HIV-1 Fusion Peptide with Phospholipid Vesicles: Different Structural Requirements for Fusion and LeakageBiochemistry, 1994
- Intraperitoneal free fatty acids induce severe hypocalcemia in rats: A model for the hypocalcemia of pancreatitisJournal of Bone and Mineral Research, 1990