Review Article

Hypophosphatemia in Coronavirus Disease 2019 (COVID-19), Complications, and Considerations: A Systematic Review

Table 1

Summary of recruited studies reporting hypophosphatemia in patients with COVID-19.

AuthorsDateStudy designSample sizeAge (years)Male (%)Levels of serum phosphate (mg/dl)Hypophosphatemia (%)Criteria for hypophosphatemiaOutcomes significantly correlating with serum phosphorusLaboratory parameters significantly correlating with serum phosphorus
(%)

Arenas et al. [28]August 2020Cross-sectionalTotal61 (100): 45 (73) vs. N/AN/AN/AN/A
ESRD patients, confirmed for COVID-1934 (55.7): 24 (70.6)
ESRD patients, suspected of COVID-1927 (44.3):21 (77.8)

Chen et al. [26]September 2021Cross-sectionalTotal823 (100): 412 (50.1)3.38 (2.91-3.78)60/637 (9.4)Serum phosphate under 0.8 mmol/l (2.48 mg/dl)AKI, death, longer hospitalizationLower lymphocyte count, serum albumin, acid uric, higher LDH and CRP
Acute kidney injury44 (6): 27 (61.4)2.51 (1.98-3.34)
No acute kidney injury779 (94): 385 (49.4)3.41 (2.94-3.78)

Javdani et al. [29]August 2020Cross-sectionalTotal36 (100)<30 years: 2 (5.6)
30-60 years: 18 (50)
≥60 years:16 (44.4)
20 (55.6) vs. N/AN/AN/AN/A
CORAD II and III5 (13.8)N/AN/A
CORAD IV and V31 (86.2)N/AN/A

Pal et al. [25]January 2021Case-controlTotal144 (100): 68 (47) vs. N/AN/AN/AN/A
Nonsevere72 (50)Median (IQR): 36 (27-48.2)
:
34 (48)
Healthy controls72 (50)Median (IQR): 35 (25.2-45.2)
:
34 (48)

Wang et al. [30]September 2021Cross-sectionalTotal435 (100)57 (41-68)200 (46)3.44 (2.97-3.87)33 (7.6)Serum phosphate under 0.8 mmol/l (2.48 mg/dl)MortalityLower lymphocyte count
Nonhypophosphatemia402 (92.4)56 (39-67)187 (46.5)3.5 (3.07-3.96)
Hypophosphatemia33 (7.6)67 (63-76)13 (39.4)2.26 ()

Xue et al. [27]March 2020Cross-sectionalTotal32 (100): 20 (62.5) vs. N/AN/AN/AAbsolute value of lymphocyte
Severe20 (62.5): 12 (60)10 (50)
Ordinary12 (37.5): 8 (66.7)N/A

Yang et al. [31]September 2020Cross-sectionalTotal226 (100):
Median (IQR): 40 (28-54)
137 (60.6)N/A44 (19.5)Serum phosphate under 0.85 mmol/l (2.65 mg/dl)ICU admission, ICU stay, CT score, oxygen saturation, respiratory rateALT/AST, CRP, lactic acid, CK, Ca
Suspected COVID-19122 (54)Median (IQR): 35 (26-53)73 (59.8)13 (10.9)
Confirmed COVID-19Total104 (46)Median (IQR): 44 (33-55)64 (61.5)30 (29.7)
Severe confirmed36 (35)Median (IQR): 47 (41-64)24 (66.6)20 (57.1)
Moderate confirmed68 (65)Median (IQR): 42 (33-52)39 (58.8)10 (15.2)

N/A: not available; IQR: interquartile range; SD: standard deviation; COVID-19: coronavirus disease 2019; ESRD: end-stage renal diseases; CORAD: COVID-19 Reporting and Data System; ICU: intensive care unit; CT: computed tomography; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CRP: C-reactive protein; CK: creatine kinase; Ca: calcium.