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0 0.5 1 1.5 2+ Mortality 53% Improvement Relative Risk Ventilation 19% ICU admission 33% Vitamin D for COVID-19  Asghar et al.  Sufficiency Are vitamin D levels associated with COVID-19 outcomes? Retrospective 91 patients in Pakistan Lower mortality with higher vitamin D levels (p=0.046) c19early.org Asghar et al., Am. J. Trop. Med. Hyg., Nov 2021 Favors vitamin D Favors control

Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among COVID-19 Patients in Pakistan

Asghar et al., Am. J. Trop. Med. Hyg., doi:10.4269/ajtmh.21-0577
Nov 2021  
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Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
 
*, now known with p < 0.00000000001 from 120 studies, recognized in 8 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,100+ studies for 60+ treatments. c19early.org
Retrospective 91 hospitalized patients in Pakistan, showing vitamin D deficiency associated with mortality in multivariate Cox regression.
This is the 103rd of 196 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 11,637 vigintillion).
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.
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.
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.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Asghar et al., 10 Nov 2021, retrospective, Pakistan, peer-reviewed, 8 authors.
This PaperVitamin DAll
Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among COVID-19 Patients in Pakistan
Muhammad Sohaib Asghar, Farah Yasmin, Kartik Dapke, Syed Muhammad Ismail Shah, Muhammad Daim Bin Zafar, Anosh Aslam Khan, Osama Mohiuddin, Salim Surani
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
Abrishami, Dalili, Torbati, Asgari, Arab-Ahmadi et al., Possible association of vitamin D status with lung involvement and outcome in patients with COVID-19: a retrospective study, Eur J Nutr
Baktash, Hosack, Patel, Shah, Kandiah et al., Vitamin D status and outcomes for hospitalised older patients with COVID-19, Postgrad Med J
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
Kloc, Ghobrial, Lipi Nska-Opałka, Wawrzyniak, Zdanowski et al., Effects of vitamin D on macrophages and myeloid-derived suppressor cells (MDSCs) hyperinflammatory response in the lungs of COVID-19 patients, Cell Immunol
Kumar, Rathi, Haq, Wimalawansa, Sharma, Putative roles of vitamin D in modulating immune response and immunopathology associated with COVID-19, Virus Res
Mahdavi, A brief review of interplay between vitamin D and angiotensin-converting enzyme 2: implications for a potential treatment for COVID-19, Rev Med Virol
Mercola, Grant, Wagner, Evidence regarding vitamin D and risk of COVID-19 and its severity, Nutrients
Murai, Effect of a single high dose of vitamin D3 on hospital length of stay in patients with moderate to severe COVID-19: a randomized clinical trial, JAMA
Szeto, Zucker, Lasota, Rubin, Walker et al., Vitamin D status and COVID-19 clinical outcomes in hospitalized patients, Endocr Res
Waldron, Ashby, Cornes, Bechervaise, Razavi et al., Vitamin D: a negative acute phase reactant, J Clin Pathol
Weir, Thenappan, Bhargava, Chen, Does vitamin D deficiency increase the severity of COVID-19?, Clin Med (Lond)
Yisak, Ewunetei, Kefale, Mamuye, Teshome et al., Effects of vitamin D on COVID-19 infection and prognosis: a systematic review, Risk Manag Healthc Policy
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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> &lt; 0.001), and death (RR: 2.98; ' '<jats:italic>P</jats:italic> &lt; 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. 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