[Dynamics the parameters of mineral metabolism in hospitalized patients with COVID-19, the impact of etiotropic and pathogenetic therapy].

Q4 Medicine
I S Maganeva, A S Bondarenko, A P Miliutina, A R Elfimova, E E Bibik, L V Nikankina, N V Tarbaeva, A K Eremkina, N G Mokrysheva
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引用次数: 0

Abstract

The high prevalence of COVID-19 requires the research progress on the disease pathogenesis. There is a lot of data confirming the association between mineral metabolism and the severity of COVID-19.

Aim: To study the dynamics of mineral metabolism parameters in patients with a confirmed COVID-19 at the time of hospitalization and after discharge, including the impact of etiotropic and pathogenetic therapy on them.

Materials and methods: A single-center study of 106 patients (aged ≥18 years) with clinically or laboratory confirmed diagnosis of COVID-19 was carried out at the Endocrinology Research Centre, Moscow. Baseline biochemical parameters, including serum calcium, phosphorus, albumin, 25(OH)D, parathyroid hormone (PTH), inflammatory markers, and instrumental assessment of COVID-19 severity were performed before specific immunotherapy, as well as on 3rd and 7th days of hospitalization and before discharge. Statistical analysis was performed with Statistica 13 software (StatSoft, USA).

Results: On the first day, hypocalcemia (low albumin-adjusted calcium level) was detected in 40.6% of cases, the prevalence of vitamin D deficiency/insufficiency amounted to 95.3% of cases. At the same time, secondary hyperparathyroidism was identified only in 14.2% of patients. A comparative analysis of mineral metabolism during hospitalization (between 1, 3, 7 days of hospitalization and before discharge) during baricitinib treatment revealed a statistically significant increase in albumin-adjusted calcium by the end of hospitalization (p<0.001, Friedman criterion, Bonferroni correction p0=0.01). A pairwise comparison of subgroups, depending on the therapy, revealed a statistically significantly lower level of albumin-adjusted calcium on 3rd day among patients on baricitinib monotherapy or combined with tocilizumab compared with a subgroup of patients undergoing etiotropic treatment (2.16 [2.13; 2.18] mmol/l vs 2.23 [2.19; 2.28] mmol/l, p=0.002, U-test, Bonferroni correction p0=0.012).

Conclusion: Patients with severe coronavirus infection are characterized by a high prevalence of vitamin D deficiency and hypocalcemia. Associations between calcium and saturation as well as the severity of lung lesion characterizes hypocalcemia as an important predictor of severe course and poor outcome in COVID-19. Pathogenetic therapy with baricitinib, including in combination with tocilizumab, contributes to achieve normocalcemia, but further studies are required.

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[新冠肺炎住院患者矿物质代谢参数的动态变化,促代谢和病因治疗的影响]。
新冠肺炎发病率高,需要对其发病机制进行研究。有大量数据证实了矿物质代谢与COVID-19严重程度之间的关系。Aim:研究确诊为COVID-19]的患者在住院和出院时的矿物质代谢参数动态,包括营养和病因治疗对他们的影响。材料和方法:在莫斯科内分泌学研究中心对106名临床或实验室确诊为新冠肺炎的患者(年龄≥18岁)进行了单中心研究。基线生化参数,包括血清钙、磷、白蛋白、25(OH)D、甲状旁腺激素(PTH)、炎症标志物和新冠肺炎严重程度的仪器评估,在特异性免疫治疗前、住院第3天和第7天以及出院前进行。使用Statistica 13软件(StatSoft,USA)进行统计分析。结果:第一天,40.6%的病例检测到低钙血症(低白蛋白调整钙水平),维生素D缺乏/不足的患病率达95.3%。同时,仅14.2%的患者出现继发性甲状旁腺功能亢进。巴里西替尼治疗期间住院期间(住院1、3、7天和出院前)的矿物质代谢的比较分析显示,到住院结束时,白蛋白调整后的钙在统计学上显著增加(p<0.001,Friedman标准,Bonferroni校正p0=0.01),结果显示,在接受巴里西替尼单药治疗或与托西利珠单抗联合治疗的患者中,第3天的白蛋白调节钙水平与接受促效治疗的患者亚组相比在统计学上显著降低(2.16[2.13;2.18]mmol/l vs 2.23[2.19;2.28]mmol/l,p=0.002,U-test,Bonferroni校正p0=0.012)。结论:严重冠状病毒感染的患者以维生素D缺乏和低钙血症的高患病率为特征。钙与饱和度以及肺部病变严重程度之间的关联表明,低钙血症是新冠肺炎严重病程和不良预后的重要预测因素。巴里西替尼的病因治疗,包括与托西利珠单抗联合治疗,有助于实现正常血钙,但还需要进一步的研究。
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来源期刊
Problemy endokrinologii
Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.40
自引率
0.00%
发文量
59
期刊介绍: Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.
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