The Impact of Late Secondary Hyperparathyroidism on Mortality in COVID-19 Patients: A Longitudinal Study

S. Hashemipour, Sabereh Afshar, Somaieh Kiani, Pouria Shahsavari, Milad Badri, Arefeh Ghobadi, Mohammad Reza Hadizadeh Khairkhahan
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Abstract

Background: Adverse effects of high parathormone hormone (PTH) in critical illness have been described in some studies. Objective: The relationship between high PTH levels with mortality in hospitalized patients with COVID-19 was evaluated in the present study. Methods: A total of 123 patients were included in the study. The patients were evaluated in phase 1 (on admission) and phase 2 (days 4-6 of hospitalization). The patients were categorized into four groups based on the PTH status in both phases: normal PTH1/normal PTH2 (group 1), high PTH1/normal PTH2 (group 2), high PTH1/high PTH2 (group 3), and normal PTH1/high PTH2 (group 4). The multiple logistic regression analysis was performed to examine the independent association of late hyperparathyroidism with mortality. After excluding ineligible participants, 115 patients in phase 1 and 96 patients in phase 2 (days 4-6 of hospitalization) were evaluated. Findings: The level of phase 2 PTH in non-survivors was significantly higher than in survivors (57.5±40.9 pg/mL vs. 27.6±16.2 pg/mL, P=0.001). The mortality rate was significantly higher in high-PTH groups in phase 2 compared to normal-PTH groups in this phase (50% and 42.9% in groups 3 and 4 vs. 6.6% and 18.2% in PTH groups 1 and 2, respectively, P=0.007). Late hyperparathyroidism was associated with 11.4 times higher mortality risk (95% CI: 2.3-56.1, P=0.003). Conclusion: Late hyperparathyroidism remained a significant predictor of mortality after adjusting for the main PTH secretion modulators and disease severity. Late hyperparathyroidism is an independent and strong risk factor for mortality in COVID-19. Further studies are necessary to clarify the mechanisms involved.
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晚期继发性甲状旁腺功能亢进对COVID-19患者死亡率的影响:一项纵向研究
背景:一些研究已经描述了高甲状旁腺激素(PTH)在危重疾病中的不良作用。目的:探讨新冠肺炎住院患者高甲状旁腺激素水平与死亡率的关系。方法:共纳入123例患者。患者在第一阶段(入院时)和第二阶段(住院4-6天)进行评估。根据两期PTH状态将患者分为PTH1/ PTH2正常组(1组)、PTH1/ PTH2高值组(2组)、PTH1/ PTH2高值组(3组)、PTH1/ PTH2正常值组(4组)。采用多元logistic回归分析晚期甲状旁腺功能亢进与死亡率的独立相关性。在排除不符合条件的参与者后,对115名1期患者和96名2期患者(住院4-6天)进行评估。结果:非幸存者2期PTH水平显著高于幸存者(57.5±40.9 pg/mL vs. 27.6±16.2 pg/mL, P=0.001)。第2期高PTH组的死亡率明显高于PTH正常组(第3和4组分别为50%和42.9%,第1和2组分别为6.6%和18.2%,P=0.007)。晚期甲状旁腺功能亢进与11.4倍的死亡风险相关(95% CI: 2.3-56.1, P=0.003)。结论:在调整了主要的甲状旁腺激素分泌调节剂和疾病严重程度后,晚期甲状旁腺功能亢进仍然是死亡率的重要预测因子。晚期甲状旁腺功能亢进是COVID-19患者死亡的一个独立且强大的危险因素。需要进一步的研究来阐明所涉及的机制。
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