THU401 Impact Of Hypercalcemia On Outcomes Among Patients Admitted With COVID-19
Authors: Krishnaraju Ellil , Deenadayalan Vaishali , Trevino Enrique Martinez , Patolia Kirtan Nandlalbhai , Olafimihan Ayobami Gbenga 
Published: October 2023

Abstract
Disclosure: E. Krishnaraju: None. V. Deenadayalan: None. E. Martinez Trevino: None. K.N. Patolia: None. A.G. Olafimihan: None.
Background Calcium plays a pivotal role in the pathogenesis of viral infections by contributing to virus development, gene expression, maturation, and release. Alterations in intracellular calcium can lead to an inflammatory signaling cascade that may result in cell injury. Previous studies have shown hypocalcemia was associated with higher mortality and worse outcomes in hospitalized and critically ill patients (PMID: 32533508). This study aims to compare the outcomes of patients admitted with COVID-19 with and without a secondary diagnosis of hypercalcemia. Methods This was a retrospective study of the 2020 National Inpatient Sample (NIS) database, utilizing ICD-10 codes to identify patients admitted for COVID-19 with and without hypercalcemia. The groups were compared based on socio-demographics, medical comorbidities, inpatient mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included a diagnosis of acute kidney injury, acute respiratory failure, pneumonia, sepsis, shock, myocardial infarction, deep venous thrombosis, pulmonary embolism, cerebrovascular accident, blood transfusions, pressor use, and need for intubation. Statistical analyses were done using t-test, univariate and multinomial logistic regression models. Results Approximately 1,058,815 patients with COVID-19 were identified and 0.3% (N=4060) were hypercalcemic on presentation. Those with hypercalcemia were more likely to be white (44.83%, p&lt;0.001), have a Charlson comorbidity index score &gt;5 (48.89%, p&lt;0.001) and have Medicare insurance (68.45%, p&lt;0.001). Among the secondary outcomes, the COVID-hypercalcemia group had significantly higher odds of having an AKI (AOR:2.47, p&lt;.001), sepsis (AOR:2.33, p&lt;0.001), shock (AOR:2.06,p&lt;.001), DVT (AOR:1.47, P:.068), CVA(AOR:2.33, p:.001), blood transfusion (AOR:1.63, p&lt;.001), intubation(AOR:2.40, p&lt;.001), and pressor use(AOR:2.03, p&lt;.001). The in-hospital mortality for patients with COVID-19 and hypercalcemia was 1.5-fold higher compared to those without hypercalcemia (aOR: 1.55, 95%CI: 1.27-1.88, P&lt;0.001) when adjusted for patient demographics, comorbidities, and hospital characteristics. It is also notable that the COVID-hypercalcemia group had an increased LOS by approximately 5 days compared to patients without hypercalcemia (aOR: 4.91, 95% CI: 3.93 - 5.89, P=0.00). Conclusion Based on the results of this large-caliber retrospective analysis, COVID-19-related mortality, length of hospital stay, and secondary clinical outcomes such as AKI, sepsis, shock, intubation, and pressor use were higher in patients with hypercalcemia and COVID compared to those without hypercalcemia. It is evident that serum calcium is yet another useful factor in determining the severity of the disease and should be considered on initial presentation of COVID-19 patients for prognostication.
Presentation Date: Thursday, June 15, 2023