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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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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. c19early.org Bilir et al., J. Contemporary Medicine, Jan 2022 Favorsvitamin D Favorscontrol 0 0.5 1 1.5 2+
Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020, now with p < 0.00000000001 from 122 studies, recognized in 9 countries.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 112 treatments. c19early.org
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: 69% [47‑82%] lower risk vs. 39% [27‑49%] 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.
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Late treatment
is less effective
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