Evidence for possible association of vitamin D status with cytokine storm and unregulated inflammation in COVID-19 patients

DOI record: { "DOI": "10.1007/s40520-020-01677-y", "ISSN": [ "1720-8319" ], "URL": "http://dx.doi.org/10.1007/s40520-020-01677-y", "abstract": "<jats:title>Abstract</jats:title><jats:sec>\n <jats:title>Objectives</jats:title>\n <jats:p>We present evidence for a possible role of Vitamin D (VitD) deficiency in unregulated cytokine production and inflammation leading to complications in COVID-19 patients.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Design</jats:title>\n <jats:p>The time-adjusted case mortality ratio (T-CMR) was estimated as the ratio of deceased patients on day <jats:italic>N</jats:italic> to the confirmed cases on day N-8. The adaptive average of T-CMR (A-CMR) was calculated as a metric of COVID-19 associated mortality. A model based on positivity change (PC) and an estimated prevalence of COVID-19 was used to determine countries with similar screening strategies. A possible association of A-CMR with the mean concentration of 25-hydroxyvitamin D (25(OH)D) in elderly individuals in countries with similar screening strategy was investigated. We considered high C-reactive protein (CRP) in severe COVID-19 patients (CRP ≥ 1 mg/dL) as a surrogate of a cytokine storm. We considered high-sensitivity CRP (hs-CRP) in healthy subjects as hs-CRP ≥ 0.2 mg/dL.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>A link between 25(OH)D and A-CMR in countries with similar screening strategy is evidence for VitD’s possible role in reducing unregulated cytokine production and inflammation among patients with severe COVID-19. We observed an odds ratio (OR) of 1.8 with 95% confidence interval (95% CI) (1.2 to 2.6) and an OR of 1.9 with 95% CI (1.4 to 2.7) for hs-CRP in VitD deficient elderly from low-income families and high-income families, respectively. COVID-19 patient-level data show an OR of 3.4 with 95% CI (2.15 to 5.4) for high CRP in severe COVID-19 patients.</jats:p>\n </jats:sec><jats:sec>\n <jats:title>Conclusion</jats:title>\n <jats:p>We conclude that future studies on VitD’s role in reducing cytokine storm and COVID-19 mortality are warranted.</jats:p>\n </jats:sec>", "alternative-id": [ "1677" ], "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "20 June 2020" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "4 August 2020" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "2 September 2020" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Change Date", "name": "change_date", "order": 4, "value": "8 December 2023" }, { 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"Ethics", "order": 3, "value": "The study is approved by the institutional review board of the National Center for Health Statistics (Continuation of Protocol #2005–06)." }, { "group": { "label": "Informed consent", "name": "EthicsHeading" }, "name": "Ethics", "order": 4, "value": "Informed consent was obtained from all participants providing vitamin D (VitD) and C-reactive protein (CRP) data used from NHANES 2009–2010." } ], "author": [ { "affiliation": [], "family": "Daneshkhah", "given": "Ali", "sequence": "first" }, { "affiliation": [], "family": "Agrawal", "given": "Vasundhara", "sequence": "additional" }, { "affiliation": [], "family": "Eshein", "given": "Adam", "sequence": "additional" }, { "affiliation": [], "family": "Subramanian", "given": "Hariharan", "sequence": "additional" }, { "affiliation": [], "family": "Roy", "given": "Hemant Kumar", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-1981-1818", "affiliation": [], "authenticated-orcid": false, 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