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入院时低钙血症是肝硬化合并COVID-19患者疾病进展的预测指标:匈牙利的一项多中心研究

Hypocalcemia on Admission Is a Predictor of Disease Progression in COVID-19 Patients with Cirrhosis: A Multicenter Study in Hungary.

作者信息

Drácz Bálint, Müller Veronika, Takács István, Hagymási Krisztina, Dinya Elek, Miheller Pál, Szijártó Attila, Werling Klára

机构信息

Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1083 Budapest, Hungary.

Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary.

出版信息

Biomedicines. 2023 May 26;11(6):1541. doi: 10.3390/biomedicines11061541.

Abstract

Hypocalcemia is a common condition in liver cirrhosis and is associated with the severity of SARS-CoV-2 infection. However, there is a lack of data demonstrating the prognostic value of hypocalcemia in COVID-19 patients with cirrhosis. This study aimed to evaluate the prognostic value of hypocalcemia for COVID-19 severity, mortality and its associations with abnormal liver function parameters. We selected 451 COVID-19 patients in this retrospective study and compared the laboratory findings of 52 COVID-19 patients with cirrhosis to those of 399 COVID-19 patients without cirrhosis. Laboratory tests measuring albumin-corrected total serum calcium were performed on admission, and the levels were monitored during hospitalization. The total serum calcium levels were significantly lower in cirrhosis cases (2.16 mmol/L) compared to those without cirrhosis (2.32 mmol/L). Multivariate analysis showed that hypocalcemia in COVID-19 patients with cirrhosis was a significant predictor of in-hospital mortality, with an OR of 4.871 ( < 0.05; 95% CI 1.566-15.146). ROC analysis showed the AUC value of total serum calcium was 0.818 (95% CI 0.683-0.953, < 0.05), with a sensitivity of 88.3% and a specificity of 75%. The total serum calcium levels showed a significant negative correlation with the Child-Turcette-Pugh score (r = -0.400, < 0.05). Hypocalcemia on admission was a significant prognostic factor of disease progression in COVID-19 patients with cirrhosis.

摘要

低钙血症是肝硬化患者的常见病症,且与新型冠状病毒肺炎(SARS-CoV-2)感染的严重程度相关。然而,目前缺乏数据证明低钙血症在肝硬化的2019冠状病毒病(COVID-19)患者中的预后价值。本研究旨在评估低钙血症对COVID-19严重程度、死亡率的预后价值及其与肝功能异常参数的关联。在这项回顾性研究中,我们选取了451例COVID-19患者,并将52例肝硬化COVID-19患者的实验室检查结果与399例无肝硬化的COVID-19患者的结果进行比较。入院时进行了测量白蛋白校正后总血清钙的实验室检测,并在住院期间监测其水平。肝硬化病例的总血清钙水平(2.16 mmol/L)显著低于无肝硬化病例(2.32 mmol/L)。多因素分析显示,肝硬化COVID-19患者的低钙血症是住院死亡率的显著预测因素,比值比为4.871(<0.05;95%置信区间1.566 - 15.146)。ROC分析显示总血清钙的AUC值为0.818(95%置信区间0.683 - 0.953,<0.05),敏感性为88.3%,特异性为75%。总血清钙水平与Child-Turcette-Pugh评分呈显著负相关(r = -0.400,<0.05)。入院时的低钙血症是肝硬化COVID-19患者疾病进展的重要预后因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2367/10295302/818822d77df3/biomedicines-11-01541-g001.jpg

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