The association between vitamin D levels and the clinical severity and inflammation markers in pediatric COVID-19 patients: single-center experience from a pandemic hospital
Bayramoğlu et al.,
The association between vitamin D levels and the clinical severity and inflammation markers in pediatric..,
European Journal of Pediatrics, doi:10.1007/s00431-021-04030-1
Retrospective 103 pediatric hospitalized COVID-19 patients, showing an association between vitamin D deficiency and clinical severity.
risk of moderate/severe case, 69.5% lower, RR 0.30, p = 0.03, high D levels 10 of 60 (16.7%), low D levels 24 of 43 (55.8%), NNT 2.6, adjusted per study, inverted to make RR<1 favor high D levels, odds ratio converted to relative risk, >12 ng/mL, multivariate logistic regression.
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Bayramoğlu et al., 31 Mar 2021, retrospective, Turkey, peer-reviewed, 7 authors.
Abstract: European Journal of Pediatrics (2021) 180:2699–2705
https://doi.org/10.1007/s00431-021-04030-1
ORIGINAL ARTICLE
The association between vitamin D levels and the clinical severity
and inflammation markers in pediatric COVID-19 patients:
single-center experience from a pandemic hospital
Elvan Bayramoğlu 1 & Gülşen Akkoç 2 & Ayşe Ağbaş 3
Hatice Nilgün Selçuk Duru 4 & Murat Elevli 4
&
Özlem Akgün 4 & Kamer Yurdakul 5
&
Received: 22 November 2020 / Revised: 8 March 2021 / Accepted: 12 March 2021 / Published online: 31 March 2021
# Springer-Verlag GmbH Germany, part of Springer Nature 2021
Abstract
Vitamin D has an immunomodulating property that regulates the inflammatory response. In this study, the aim was to evaluate the
relationship between vitamin D levels and clinical severity and inflammation markers in children and adolescents with COVID-19. The
clinical and laboratory records of 103 pediatric cases with COVID-19, whose vitamin D levels had been measured, were retrospectively
reviewed. The cases were divided into groups according to their clinical severity (asymptomatic, mild, and moderate-to-severe) and
vitamin D levels. The moderate-to-severe clinical group had significantly higher inflammation markers (CRP, procalcitonin, fibrinogen, Ddimer) and a lower lymphocyte count compared to both the mild and asymptomatic groups. The 25 OH vitamin D levels were also
significantly lower (p < 0.001), and the ratio of vitamin D deficiency was 70.6% in the moderate-to-severe group. The vitamin D–deficient
group had a significantly higher age and fibrinogen levels while also having a lower lymphocyte count compared to the insufficient and
normal groups. The 25 OH vitamin D level was correlated positively with the lymphocyte count (r = 0.375, p = <0.001), and negatively
with age (r = −0.496, p = <0.001), CRP (r = −0.309, p = 0.002) and fibrinogen levels (r = −0.381, p = <0.001). In a logistic regression
analysis, vitamin D deficiency, D-dimer, and fibrinogen levels on admission were independent predictors of severe clinical course.
Conclusion: This study revealed an association between vitamin D deficiency and clinical severity, in addition to inflammation markers in pediatric COVID-19 cases. Prophylactic vitamin D supplementation may be considered, especially in the
adolescent age group.
What is Known:
• • The pathology of COVID-19 involves a complex interaction between the SARS-CoV-2 and the immune system. Hyperinflammation/cytokine storm is
held responsible for the severity of the disease.
• Vitamin D has multiple roles in the immune system that can modulate the body reaction to an infection.
What is New:
• • Clinically more severe group had significantly lower vit D levels and significantly higher inflammation markers.
• Lower 25 OH vit D levels were associated with higher inflammation markers, suggesting an important role of vitamin D in the clinical course of
COVID-19 in children and adolescents probably by regulating the systemic inflammatory response.
Keywords COVID-19 . Vitamin D . Inflammation . Children . Pediatric
Communicated by Peter de Winter
* Elvan Bayramoğlu
elvanbayramoglu@gmail.com
Gülşen Akkoç
agulsenakkoc@gmail.com
Ayşe Ağbaş
yurtayse@hotmail.com
Özlem Akgün
drozlemakgun@hotmail.com
Kamer Yurdakul
kamer_dogan@yahoo.com
Hatice Nilgün Selçuk Duru
nilgunduru@yahoo.com
Murat Elevli
muratelevli@gmail.com
Extended author information available on the last page of the article
2700
Eur J Pediatr (2021)..
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