Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among COVID-19 Patients in Pakistan
et al., Am. J. Trop. Med. Hyg., doi:10.4269/ajtmh.21-0577, Nov 2021
Vitamin D for COVID-19
8th treatment shown to reduce risk in
October 2020, now with p < 0.00000000001 from 126 studies, recognized in 18 countries.
No treatment is 100% effective. Protocols
combine treatments.
6,200+ studies for
200+ treatments. c19early.org
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Retrospective 91 hospitalized patients in Pakistan, showing vitamin D deficiency associated with mortality in multivariate Cox regression.
This is the 102nd of 226 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 115,066,047,903,039,356,928 vigintillion).
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risk of death, 53.1% lower, HR 0.47, p = 0.046, high D levels (≥10ng/mL) 73, low D levels (<10ng/mL) 18, inverted to make HR<1 favor high D levels (≥10ng/mL), multivariate Cox regression.
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risk of mechanical ventilation, 19.4% lower, HR 0.81, p = 0.32, high D levels (≥10ng/mL) 5 of 73 (6.8%), low D levels (<10ng/mL) 6 of 18 (33.3%), NNT 3.8, adjusted per study, inverted to make HR<1 favor high D levels (≥10ng/mL), multivariate Cox regression.
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risk of ICU admission, 32.9% lower, HR 0.67, p = 0.54, high D levels (≥10ng/mL) 73, low D levels (<10ng/mL) 18, inverted to make HR<1 favor high D levels (≥10ng/mL), multivariate Cox regression.
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| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Asghar et al., 10 Nov 2021, retrospective, Pakistan, peer-reviewed, 8 authors.
Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among COVID-19 Patients in Pakistan
The American Journal of Tropical Medicine and Hygiene, doi:10.4269/ajtmh.21-0577
The risk of acute respiratory tract infections is particularly pronounced in patients deficient in 25-hydroxyvitamin D (25(OH)D). With respect to COVID-19, there are conflicting evidence on the association of 25(OH)D levels with disease severity. We undertook this study to evaluate the 25(OH)D status in COVID-19 patients admitted in Karachi, Pakistan, and associated vitamin D deficiency with primary outcomes of mortality, length of stay, intubation, and frequency of COVID-19 symptoms. A total of 91 patients were evaluated for 25(OH)D status during their COVID-19 disease course. 25-hydroxyvitamin D levels were classified as deficient (, 10 ng/mL), insufficient (10-30 ng/mL), or sufficient (. 30 ng/mL). The study population comprised 68.1% males (N 5 62). The mean age was 52.6 6 15.7 years. Vitamin D deficiency was significantly associated with intensive care unit (ICU) admission (RR: 3.20; P 5 0.048), invasive ventilation (RR: 2.78; P 5 0.043), persistent pulmonary infiltrates (RR: 7.58; P , 0.001), and death (RR: 2.98; P , 0.001) on univariate Cox regression. On multivariate Cox regression, only death (RR: 2.13; P 5 0.046) and persistent pulmonary infiltrates (RR: 6.78; P 5 0.009) remained significant after adjustment for confounding factors. On Kaplan Meier curves, vitamin D deficient patients had persistent pulmonary infiltrates and a greater probability of requiring mechanical ventilation than patients with 25(OH)D $ 10 ng/mL. Mechanical ventilation had to be initiated early in the deficient group during the 30-day hospital stay (Chi-square: 4.565, P 5 0.033). Patients with 25(OH)D $ 10 ng/mL also demonstrated a higher probability of survival than those with 25(OH)D concentrations , 10 ng/mL. 25-hydroxyvitamin D deficient population had longer hospital stays and worse outcomes.
References
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G€ Uven, G€ Ultekin H, The effect of high-dose parenteral vitamin D3 on COVID-19-related inhospital mortality in critical COVID-19 patients during intensive care unit admission: an observational cohort study, Eur J Clin Nutr
Hutchings, Patients hospitalized with COVID-19 have low levels of 25-hydroxyvitamin D, Endocrine
Kaufman, Niles, Kroll, Bi, Holick, SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels, PLoS One
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"abstract": "<jats:title>ABSTRACT.</jats:title>\n<jats:p>The risk of acute respiratory tract infections is particularly pronounced in patients deficient in 25-hydroxyvitamin D (25(OH)D). With respect to COVID-19, there are conflicting evidence on the association of 25(OH)D levels with disease severity. We undertook this study to evaluate the 25(OH)D status in COVID-19 patients admitted in Karachi, Pakistan, and associated vitamin D deficiency with primary outcomes of mortality, length of stay, intubation, and frequency of COVID-19 symptoms. A total of 91 patients were evaluated for 25(OH)D status during their COVID-19 disease course. 25-hydroxyvitamin D levels were classified as deficient (< 10 ng/mL), insufficient (10–30 ng/mL), or sufficient (> 30 ng/mL). The study population comprised 68.1% males (<jats:italic>N</jats:italic> = 62). The mean age was 52.6 ± 15.7 years. Vitamin D deficiency was significantly associated with intensive care unit (ICU) admission (RR: 3.20; <jats:italic>P</jats:italic> = 0.048), invasive ventilation (RR: 2.78; <jats:italic>P</jats:italic> = 0.043), persistent pulmonary infiltrates (RR: 7.58; <jats:italic>P</jats:italic> < 0.001), and death (RR: 2.98; <jats:italic>P</jats:italic> < 0.001) on univariate Cox regression. On multivariate Cox regression, only death (RR: 2.13; <jats:italic>P</jats:italic> = 0.046) and persistent pulmonary infiltrates (RR: 6.78; <jats:italic>P</jats:italic> = 0.009) remained significant after adjustment for confounding factors. On Kaplan Meier curves, vitamin D deficient patients had persistent pulmonary infiltrates and a greater probability of requiring mechanical ventilation than patients with 25(OH)D ≥ 10 ng/mL. Mechanical ventilation had to be initiated early in the deficient group during the 30-day hospital stay (Chi-square: 4.565, <jats:italic>P</jats:italic> = 0.033). Patients with 25(OH)D ≥ 10 ng/mL also demonstrated a higher probability of survival than those with 25(OH)D concentrations < 10 ng/mL. 25-hydroxyvitamin D deficient population had longer hospital stays and worse outcomes.</jats:p>",
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