Nutritional Advice El Mondo
Objectives:
Is hypocalcemia associated with poor outcome in COVID-19 patients?
Study design:
This review article included 7 studies with 2,032 COVID-19 patients.
Results and conclusions:
The investigators found the prevalence of hypocalcemia in the included studies was 55% [95% CI = 23 to 87%]. The incidence of poor outcome in this review article was 26%.
The investigators found serum calcium level was lower in patients with poor outcome [mean difference = -0.173 mmol/L, 95% CI = -0.259 to -0.087, p 0.001, I2 = 31.3%].
The investigators found hypocalcemia was associated with poor outcome [OR = 3.19, 95% CI = 2.02 to 5.06, p 0.001, I2 = 32.86%]; with sensitivity of 0.74 [95% CI = 0.53 to 0.88], specificity of 0.54 [95% CI = 0.29 to 0.77], positive likelihood ratio of 1.6 [95% CI = 1.1 to 2.3], negative likelihood ratio of 0.49 [95% CI = 0.35 to 0.66], diagnostic odds ratio of 3 [95% CI = 2 to 5] and area under curve of 0.70 [95% CI = 0.66 to 0.74].
The investigators found the association between hypocalcemia and poor outcome had a symmetrical funnel-plot and egger’s test showed indication of small-study effects [p = 0.042]. Trim-and-fill analysis using Run R0 estimator resulted in OR of 2.54 [95% CI = 1.85 to 3.49] after imputation to the left side of the funnel plot.
The investigators found meta-regression analysis indicated that the association between hypocalcemia and poor outcome was influenced by hypertension [OR = 0.96, 95% CI = 0.93 to 1.00, p = 0.47], but not age [p = 0.383], male gender [p = 0.071] and [diabetes p = 0.114].
The investigators found in pooled analysis, that the post-test probability was 36% in patients with hypocalcemia and 15% in patients without hypocalcemia.
The investigators concluded hypocalcemia can be used as one of predictor of poor outcome in patients with COVID-19. However, it is better used as one of markers in a prediction model, rather than used alone. Whether calcium supplementation will be beneficial in patients with hypocalcemia requires further investigations.
Original title:
Hypocalcemia is associated with severe COVID-19: A systematic review and meta-analysis and Martha JW, Wibowo A and Pranata R.
Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832827/
Additional information of El Mondo:
Find more information/studies on coronavirus and calcium right here.
Hypocalcaemia is low calcium levels in the blood serum. The normal range is 2.1 to 2.6 mmol/L with levels less than 2.1 mmol/l defined as hypocalcemia.