Low Vitamin D COVID-19 tied to Severity


One research reported that patients hospitalized with COVID-19 had worse outcomes than normal levels of vitamin D.

Low levels of 25-hydroxyvitamin D [25(OH)D] Hospitalized COVID-19 patients were associated with the development of acute respiratory distress syndrome (ARDS), with the need for admission to the ICU (OR 1.06, 95% CI 1.01–1.12). P= 0.038), according to Luigi Gennari, MD of the University of Siena in Italy, at the American Society for Bone and Mineral Research Virtual Meeting.

Levels of 25 (OH) D below 20 ng / ml were also associated with higher mortality in these patients (OR 1.18, 95% CI 1.02–1.37). P= 0.029), according to Gennari and colleagues.

“The clinical consequences of infection with the Cirrus COVID-19 virus vary from benign to fatal,” Gennari said. While many patients are asymptomatic, others have mild symptoms, and some have a severe life-threatening illness, characterized primarily by interstitial pneumonia that leads to death from ARDS and respiratory failure, as well as other complications. May occur.

Vitamin D is an important regulator of immune function and regulates the inflammatory response to infection. “In fact, vitamin D through its receptor can be implicated in the regulation of multiple pathways that are involved in the progression and severity of COVID-19 by shutting down cytokine storms, protecting the integrity of epithelial inhibitors and limiting prothrombotic . Usually seen in severe COVID-19 cases, “he said.

In addition, vitamin D is an important regulator of the renin-angiotensin system, whose dysfunction has been implicated in the pathogenesis of ARDS.

Several lines of evidence suggest that 25 (OH) D deficiency may be a risk factor for severe COVID-19 infection. For example, some demographic groups known to be at high risk for vitamin D deficiency such as blacks, the elderly, nursing home residents, and individuals with obesity or diabetes are at high risk of Kovid-19 infection and mortality. A recent study reported that patients with insufficient vitamin D levels had nearly twice the risk of testing positive for COVID-19.

Previous studies have also shown that low 25 (OH) D status is commonly associated with increased risks for respiratory tract infections, and that vitamin D supplementation reduces the risk of respiratory tract infections, Especially for people with low 25 (OH) D levels.

“Italy is generally regarded as one of the European countries with the highest levels of 25 (OH) D deficiency, especially in winter. The COVID-19 mortality has been particularly high in our country, but in the summer months. There is a decline when there is a deficiency of Vitamin D. There is less, ”said Gennari.

To investigate the possible relationship between the 25 (OH) D levels and the level of COVID-19 results, Gennari’s group enrolled 103 patients with severely diseased COVID-19, who had been diagnosed since March 9. By April, San Luka Hospital in Milan was admitted to the COVID-19 unit. 30, 2020. They were compared with 52 individuals with asymptomatic or only mildly symptomatic COVID-19 and 206 age- and sex-matched controls whose 25 (OH) D levels were measured during routine health screening. The average age of the participants was 66. Older, male sex and severely prophylactic COVID-19 had significantly lower levels of 25 (OH) D than those with mild disease or control.

Vitamin D levels were also inversely associated with interleukin (IL) -6 and C-reactive protein levels, both associated with inflammatory status, and IL-6 as a potential marker of COVID-19 severity. Has been suggested in

At the time of hospital admission, 25.2 (OH) levels were lower in the severe symptomatic group, at 18.2 ng / ml, 30.3 ng / ml in the mild symptomatic group and 25.4 ng / ml in the controls (P<0.0001 for both comparisons). Subsequently, 54 of the diseased patients were admitted to the ICU due to the development of ARDS. Those patients who did not require admission to the ICU had lower levels of 25 (OH) D, 14.4 ng / ml, and also higher levels of 49.6 pg / ml, compared with patients who had a level of 22.4 ng / ml.P= 0.0001) and 28.8 pg / mL (P= 0.016), respectively. They were also more often male and had at least one comradity.

A total of 19 patients died of ARDS. Compared to patients who survived, those who died had a lower level of 25 (OH) D (13.2 vs. 19.3 ng / ml) P= 0.03) and higher levels of IL-6 (61 vs. 34.9 pg / mL,) P= 0.02).

“Interestingly, the inverse relationship with admission and mortality in the ICU was independent of IL-6 levels and the presence of major comorbidities,” he said.

“Thus, despite the limitation of a small sample size, our results support the need for intervention trials aimed at finding whether vitamin D supplementation may limit the risk of respiratory failure in patients with COVID-19, And suggests that improvement of vitamin D deficiency may be of relevance to reducing the clinical burden during future outbreaks of SARS COVID-19, ”he concluded.

Disclosures

Gennari stated no relevant relationship with the industry.

    .