Yang C, Ma X, Wu J, Han J, Zheng Z, Duan H, Liu Q, Wu C, Dong Y, Dong L. Low serum calcium and phosphorus and their clinical performance in detecting COVID-19 patients. J Med Virol. 2020 Sep 14. doi: 10.1002/jmv.26515. Epub ahead of print. PMID: 32926424.

Background: This study aimed to evaluate the predictive performance of low serum calcium and phosphorus in discriminative diagnosis of the severity of COVID-19 patients.

Methods: We conducted a single-center hospital-based study and consecutively recruited 122 suspected and 104 confirmed COVID-19 patients during January 24 to April 25, 2020. The clinical risk factors of COVID-19 were identified. The discriminative power of low calcium and phosphorus regarding the disease severity was evaluated.

Results: Low calcium and low phosphorus are more prevalent in severe/critical COVID-19 patients than moderate COVID-19 patients (OR 15.07, 95%CI 1.59 -143.18 for calcium, OR 6.90, 95%CI 2.43 – 19.64 for phosphorus). The specificity in detecting the severe/critical patients among COVID-19 patients reached 98.5% (95%CI 92.0-99.7%) and 84.4% (95%CI 74.3-91.6%) by low calcium and low phosphorus, respectively, albeit with suboptimal sensitivity. Calcium and phosphorus combined with lymphocyte count could obtain the best discriminative performance for the severe COVID-19 patients (area under the curve (AUC) = 0.80), and combined with oxygenation index was promising (AUC = 0.71). Similar discriminative performances of low calcium and low phosphorus were found between suspected and confirmed COVID-19 patients.

Conclusions: Low calcium and low phosphorus could indicate the severity of COVID-19 patients, and may be utilized as a promising clinical biomarker for discriminative diagnosis

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