Abstract: Nutrition, Metabolism & Cardiovascular Diseases (2021) 31, 774e775
Available online at www.sciencedirect.com
Nutrition, Metabolism & Cardiovascular Diseases
journal homepage: www.elsevier.com/locate/nmcd
LETTER TO THE EDITOR
Excessive vitamin B12 and poor outcome in COVID-19 pneumonia
To the Editor,
The Severe Acute Respiratory Syndrome (SARS) related to
COVID-19 infection is a hard-to-treat disease with a poor
prognosis. High casualty rate has been reported in the
frail elderly where malnutrition and defective micronutrient state may both impair the immune response [1].
Rodriguez et all showed that 2% of patients admitted to
an Intensive Care Unit (ICU) were Vitamin B12 deficient
[2]. Low plasma vitamin B12 (B12) and folate levels may
also be associated with high homocysteine concentration.
Moreover, vitamin B12 supplementation has been
showed to add favourably to chronic hepatitis C treatment [3]. Aim of our study was to study prospectively
vitamin B12 and folate plasma level in patients admitted
for COVID Pneumonia. 51 patients diagnosed with SARSCov2 pharyngeal nose swab hospitalized at our internal
medicine unit from 30Th March to 30Th April 2020 were
considered for the study. 2 patients were excluded for
ongoing vitamin supplementation. 49 patients (males
64.5%; median age 72 years, IQR Z 22 years) underwent
extensive blood test, including B12, folates and blood gas
analysis. Results were correlated with the outcome with a
worse outcome intended as transfer to ICU or death.
Continuous variables are expressed as mean standard
deviation (SD) and as median with Inter-Quartile Range
(IQR) depending on data distribution; discrete variables
are expressed as number and percentage. Comparison
between continuous variables is performed using the
Student’s T test for unpaired data and/or the ManneWhitney U test, depending on the distribution of the
data. A stepwise multivariate linear regression analysis
was performed in order to determine any independent
determinants of outcome.
Nine out of 49 patients were transferred to the ICU or
died. Patients with poor outcome were significantly older
(p Z 0.01), had lower P/F ratio (p Z 0.01) and higher
plasma level of B12 (p Z 0.02) compared with those who
recovered. In a multivariate regression analysis, only age
was independently associated with a worse outcome
(bSEM 0.016 0.005, p Z 0.001). No significant differences were noticed as regards to folates, transaminases,
D-dimer, homocysteine, and fibrinogen (Table 1) A
shortage of B vitamins may weaken host immune
response [1]. One might postulate B12 as basic treatment
option for COVID-19 illness. However, B12 status has not
been previously assessed in this population. Unexpectedly, our data do not support a potential therapeutic role
of B12 supplementation for a low 2% rate of B12 deficiency and normal homocysteine levels were not consistent with a significant B12 shortage [4]. Unfortunately, we
did not perform plasma methylmalonic acid evaluation
which is the most sensitive marker for B12 deficiency.
However, a potential association between high plasma
levels of vitamin B12 and increased risk of mortality is
suggested. Moreover, it has been reported that the
cyanocobalamin fraction of B12 may worsen prognosis of
renal insufficiency patients [4]. However, no difference of
B12 levels were found when the population was divided
for glomerular filtration rate (GFR) by a post-hoc analysis
with few patients showing altered GFR. Our study supports recent..
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