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. 2021 Feb;40(2):104-110.
doi: 10.1080/07315724.2020.1856013. Epub 2021 Jan 12.

Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19

Salam Bennouar  1 , Abdelghani Bachir Cherif  2 , Amel Kessira  3 , Djamel-Eddine Bennouar  3 , Samia Abdi  1
Affiliations

Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19

Salam Bennouar et al. J Am Coll Nutr. 2021 Feb.

Abstract

Background: The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality.

Materials: This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve.

Results: Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (pLog-Rank = 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively. Hazard ratios were (HR = 6.9, 95% CI [2.0-24.1], p = 0.002 and HR = 6.2, 95% CI [2.1-18.3], p = 0.001) respectively.

Conclusion: This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.

Keywords: COVID-19; hypocalcemia; in-hospital mortality; vitamin D deficiency.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Mortality rates according to 25 (OH) D levels (a) and serum calcium tertiles, (b) in severe COVID-19 patients.
Figure 2.
Figure 2.
Kaplan-Meier curve for crude cumulative in-hospital mortality by 25(OH) D levels (a) and serum calcium tertiles (b) in severe COVID-19 patients.
Figure 3.
Figure 3.
Receiver operating characteristic curve of 25(OH) D and serum calcium in predicting in-hospital mortality of severe COVID-19 patients.
See this image and copyright information in PMC

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