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0 0.5 1 1.5 2+ Mortality 23% Improvement Relative Risk Ventilation 3% Weaning from intubation 20% ICU time 10% Hospitalization time 3% Vitamin D for COVID-19  Bilir et al.  ICU PATIENTS Is very late treatment with vitamin D beneficial for COVID-19? Retrospective 80 patients in Turkey (March - July 2021) Lower mortality (p=0.26) and improved recovery (p=0.13), not sig. Bilir et al., J. Contemporary Medicine, Jan 2022 Favors vitamin D Favors control

Does Vitamin D Supplementation Reduce Cytokine Storm and Mortality in Geriatric Intensive Care Patients Diagnosed with COVID-19

Bilir et al., Journal of Contemporary Medicine, doi:10.16899/jcm.990057
Jan 2022  
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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.
Retrospective 80 elderly ICU patients in Turkey, 40 with vitamin D levels <30ng/ml received vitamin D treatment, showing no significant differences in outcomes. Although not statistically significant, results favored treatment which suggests that supplemention was beneficial because low vitamin D levels are typically associated with worse results.
Cholecalciferol was used in this study. Meta analysis shows that late stage treatment with calcitriol / calcifediol (or paricalcitol, alfacalcidol, etc.) is more effective than cholecalciferol: 65% [41‑79%] lower risk vs. 39% [26‑49%] lower risk. Cholecalciferol requires two hydroxylation steps to become activated - first in the liver to calcifediol, then in the kidney to calcitriol. Calcitriol, paricalcitol, and alfacalcidol are active vitamin D analogs that do not require conversion. This allows them to have more rapid onset of action compared to cholecalciferol. The time delay for cholecalciferol to increase serum calcifediol levels can be 2-3 days, and the delay for converting calcifediol to active calcitriol can be up to 7 days.
This study is excluded in meta analysis: control group formed from patients with high vitamin D levels.
risk of death, 23.1% lower, RR 0.77, p = 0.26, treatment 20 of 40 (50.0%), control 26 of 40 (65.0%), NNT 6.7.
risk of mechanical ventilation, 3.3% lower, RR 0.97, p = 1.00, treatment 29 of 40 (72.5%), control 30 of 40 (75.0%), NNT 40.
risk of no weaning from intubation, 20.4% lower, RR 0.80, p = 0.13, treatment 20 of 29 (69.0%), control 26 of 30 (86.7%), NNT 5.6.
ICU time, 10.3% lower, relative time 0.90, p = 0.44, treatment 40, control 40.
hospitalization time, 2.9% lower, relative time 0.97, p = 0.98, treatment 40, control 40.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Bilir et al., 1 Jan 2022, retrospective, Turkey, peer-reviewed, 7 authors, study period March 2021 - July 2021, dosage 50,000IU days 1, 8.
This PaperVitamin DAll
Does Vitamin D Supplementation Reduce Cytokine Storm and Mortality in Geriatric Intensive Care Patients Diagnosed with COVID-19
Yeliz Bilir, Akın Bilir, Ayten Saracoğlu, Fulya Çiyiltepe, Elif Bombaci, Kemal Tolga Saraçoğlu, Recep Demirhan
Journal of Contemporary Medicine, doi:10.16899/jcm.990057
Introduction: Coronavirus disease progresses from an asymptomatic stage to a fatal stage characterized by a cytokine storm. The present study aimed to emphasize the therapeutic effect of vitamin-D supplementation and its potential importance in reducing the disease severity in older adults in the intensive care unit after COVID-19 diagnosis. Materials and Method: The data of 80 patients aged ≥ 65 years who followed up in intensive care clinic. The inflammatory parameters and clinical course of 40 patients whose serum 25-hydroxyvitamin-D level was below 30 ng/ml and who received vitamin-D supplementation (case-group) were recorded on the fifth and tenth days of follow-up and compared with those of the other 40 patients 40 patients who vitamin D supplementation was not started because of high vitamin D levels (control-group). Results: Of the 80 patients, 40 (50%) were male and 40 (50%) were female. The mean age of the patients was 72±10.8 years. The mean vitamin D level of the case group was 11.6 ng/ml. On the 10. day levels of the inflammatory markers C-Reactive Protein, Procalcitonin, D-Dimer, Ferritin, Interleukin-6 and Lactate Dehydrogenase were significantly lower and the lymphocyte count was significantly higher in the case group than in the control group. On the 5. day, the interleukin-6 level was significantly lower in the case group. Weaning was performed in nine and four patients in the case and control groups, respectively. There was no significant difference in mortality rates between the groups. Conclusion: Vitamin-D supplementation can help reduce cytokine response. Recommended prophylactically or therapeutically at all stages of coronavirus disease.
Adamo, Yoshikawa, Ouslander, Coronavirus disease 2019 in geriatrics and long-term care:the ABCDs of COVID-19, J Am Geriatr Soc
Alıpıo, Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus
Ardizzone, Cassinotti, Trabattoni, Immunomodulatoryeffects of 1,25-dihydroxyvitamin D3 on TH1/TH2 cytokines in inflammatory bowel disease:an in vitro study, Int J Immunopathol Pharmacol
Autier, Mullie, Macacu, Effect of vitamin D supplementation on non-skeletaldisorders:a systematic review of meta-analyses and randomised trials, Lancet Diabetes Endocrinol
Baktash, Hosack, Patel, Vitamin D status and outcomes for hospitalised older patients with COVID-19, Postgrad Med J
Beard, Bearden, Striker, Vitamin D and the anti-viral state, J Clin Virol
Binkley, Ramamurthy, Krueger, Low vitamin D status:definition, prevalence, consequences, andcorrection, Endocrinol Metab Clin North Am
Boucher, Theproblems of vitamin d insufficiency in older people, Aging Dis
Conti, Ronconi, Caraffa, Induction of pro-inflammatorycytokines (IL-1 andIL-6) and lung inflammation by Coronavirus-19 (COVID-19 or SARS-CoV-2):anti-inflammatory strategies, J Biol Regul Homeost Agents
Duru, Hastalarda, COVID-19. diğer:Göğüs Hastalıkları Uzmanlarının Bilmesi Gerekenler'başlıklı ek sayısında derlemeyi
Gheblawi, Wang, Viveiros, Angiotensin-Converting Enzyme 2:SARS-CoV-2 Receptorand Regulator of the Renin-Angiotensin System:Celebrating the 20th Anniversary of the Discovery of ACE2, Circ Res
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Hribar, Cobbold, Church, Potential Role of Vitamin D in the Elderly to Resist COVID-19 and to Slow Progression of Parkinson's Disease, Brain Sci
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Martineau, Jolliffe, Hooper, Vitamin D supplementation to prevent acute respiratory tract infections:systematic review and metaanalysis of individual participant data, BMJ
Panarese, Shahini, Letter:Covid-19, and vitamin D, Aliment Pharmacol Ther
Rhodes, Subramanian, Laird, Editorial:low population mortality from COVID-19 in countriessouth of latitude 35 degrees North supports vitamin D as a factor determining severity, Aliment Pharmacol Ther
Teymoori-Rad, Shokri, Salimi, The inter play between vitamin D and viral infections, Rev Med Virol
Thomas, Thadhani, Hypovitaminosis D in medical in patients, N Engl J Med
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Late treatment
is less effective
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