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Hypocalcemia in COVID-19 is associated with low vitamin D levels and impaired compensatory PTH response.
di Filippo, Luigi; Allora, Agnese; Locatelli, Massimo; Rovere Querini, Patrizia; Frara, Stefano; Banfi, Giuseppe; Giustina, Andrea.
  • di Filippo L; Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Allora A; Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Locatelli M; Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Rovere Querini P; Division of Immunology, Transplantation and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Frara S; Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
  • Banfi G; IRCCS Istituto Ortopedico Galeazzi, Laboratory of Experimental Biochemistry & Molecular Biology, Università Vita-Salute San Raffaele, Milan, Italy.
  • Giustina A; Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy. giustina.andrea@hsr.it.
Endocrine ; 74(2): 219-225, 2021 11.
Article in English | MEDLINE | ID: covidwho-1442182
ABSTRACT

BACKGROUND:

Hypocalcemia has been identified as a major distinctive feature of COVID-19, predicting poor clinical outcomes. Among the mechanisms underlying this biochemical finding, high prevalence of vitamin D (VD) deficiency in COVID-19 patients reported so far in several studies was advocated. However, robust data in favor of this hypothesis are still lacking. Therefore, aim of our study was to investigate the role of hypovitaminosis D and parathyroid hormone (PTH) levels in the development of hypocalcemia in COVID-19 patients.

METHODS:

Patients admitted to IRCCS Ospedale San Raffaele for COVID-19 were enrolled in this study, excluding those with comorbidities and therapies influencing calcium and VD metabolism. Serum levels of total calcium (tCa), ionized calcium (Ca2+), 25-OH-VD, and PTH were evaluated at admission. We defined VD deficiency as VD below 20 ng/mL, hypocalcemia as tCa below 2.2 mmol/L or as Ca2+ below 1.18 mmol/L, and hyperparathyroidism as PTH above 65 pg/mL.

RESULTS:

A total of 78 patients were included in the study. Median tCa and Ca2+ levels were 2.15 and 1.15 mmol/L, respectively. Total and ionized hypocalcemia were observed in 53 (67.9%) and 55 (70.5%) patients, respectively. VD deficiency was found in 67.9% of patients, but secondary hyperparathyroidism was detected in 20.5% of them, only. tCa levels were significantly lower in patients with VD deficiency and regression analyses showed a positive correlation between VD and tCa.

CONCLUSIONS:

In conclusion, we confirmed a high prevalence of hypocalcemia in COVID-19 patients and we showed for the first time that it occurred largely in the context of marked hypovitaminosis D not adequately compensated by secondary hyperparathyroidism.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Parathyroid Hormone / Vitamin D Deficiency / COVID-19 / Hyperparathyroidism, Secondary / Hypocalcemia Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Country/Region as subject: Europa Language: English Journal: Endocrine Journal subject: Endocrinology Year: 2021 Document Type: Article Affiliation country: S12020-021-02882-z

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Parathyroid Hormone / Vitamin D Deficiency / COVID-19 / Hyperparathyroidism, Secondary / Hypocalcemia Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Humans Country/Region as subject: Europa Language: English Journal: Endocrine Journal subject: Endocrinology Year: 2021 Document Type: Article Affiliation country: S12020-021-02882-z