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Meta-Analysis
. 2021 Jan-Feb;15(1):337-342.
doi: 10.1016/j.dsx.2021.01.003. Epub 2021 Jan 18.

Hypocalcemia is associated with severe COVID-19: A systematic review and meta-analysis

Januar Wibawa Martha  1 , Arief Wibowo  2 , Raymond Pranata  3
Affiliations
Meta-Analysis

Hypocalcemia is associated with severe COVID-19: A systematic review and meta-analysis

Januar Wibawa Martha et al. Diabetes Metab Syndr. 2021 Jan-Feb.

Abstract

Background and aims: Hypocalcemia is commonly in critically ill patients and studies have shown that hypocalcemia is prevalent in patients with COVID-19. This meta-analysis aimed to evaluate the prognostic performance of hypocalcemia in patients with coronavirus disease 2019 (COVID-19).

Methods: We performed a systematic literature search on PubMed, Scopus, and Embase with keywords "SARS-CoV-2″ OR″COVID-19″ OR ″2019-nCoV" AND "hypocalcemia" up until 10 December 2020. The key exposure was hypocalcemia, defined as serum calcium below study-defined cut-off points. The main outcome was poor outcome, which was a composite of mortality and severity. The effect estimate of the main outcome was reported as odds ratio (OR) and its 95% confidence interval (95% CI). We also generate sensitivity, specificity, positive and negative likelihood ratio (PLR & NLR), diagnostic odds ratio (DOR), and area under curve (AUC).

Results: There are 2032 patients from 7 studies included in this systematic review and meta-analysis. The incidence of poor outcome in this study was 26%. Serum calcium was lower in patients with poor outcome (mean difference -0.173 mmol/L [-0.259, -0.087], p < 0.001; I2: 31.3%). Hypocalcemia was associated with poor outcome (OR 3.19 [2.02, 5.06], p < 0.001; I2: 32.86%); with sensitivity of 0.74 [0.53, 0.88], specificity of 0.54 [0.29, 0.77], PLR of 1.6 [1.1, 2.3], NLR of 0.49 [0.35, 0.66], DOR of 3 [2, 5], and AUC of 0.70 [0.66, 0.74]. In this pooled analysis, the post-test probability was 36% in patients with hypocalcemia and 15% in patients without hypocalcemia.

Conclusion: Hypocalcemia was associated with poor outcome in COVID-19 patients.

Prospero id: CRD42020225506.

Keywords: Coronavirus; Hypocalcemia; Mortality; Severity; Ventilation.

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Conflict of interest statement

Declaration of competing interest The authors declared no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart.
Fig. 2
Fig. 2
Forest-plot for hypocalcemia and composite poor outcome.
Fig. 3
Fig. 3
Pooled sensitivity and specificity.
Fig. 4
Fig. 4
SROC with prediction & confidence contours.
Fig. 5
Fig. 5
Fagan’s nomogram.
See this image and copyright information in PMC

Comment in

References

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