Association of vitamin D deficiency with COVID-19 severity and mortality in Iranian people: a prospective observational study
et al., Acute and Critical Care, doi:10.4266/acc.2021.00605, Nov 2021
Vitamin D for COVID-19
8th treatment shown to reduce risk in
October 2020, now with p < 0.00000000001 from 126 studies, recognized in 18 countries.
No treatment is 100% effective. Protocols
combine treatments.
6,300+ studies for
210+ treatments. c19early.org
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Prospective study of 248 hospitalized COVID+ patients in Iran with vitamin D levels measured in the previous year and again at admission, showing vitamin D status associated with severity and mortality.
This is the 109th of 226 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 115,066,047,903,039,356,928 vigintillion).
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risk of death, 42.0% lower, RR 0.58, p = 0.07, high D levels 18 of 139 (12.9%), low D levels 25 of 109 (22.9%), NNT 10, inverted to make RR<1 favor high D levels, odds ratio converted to relative risk, vitamin D measured prior to COVID-19, multivariate.
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risk of death, 51.1% lower, RR 0.49, p = 0.02, high D levels 13 of 115 (11.3%), low D levels 30 of 133 (22.6%), NNT 8.9, inverted to make RR<1 favor high D levels, odds ratio converted to relative risk, vitamin D measured on admission, multivariate.
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risk of severe case, 37.9% lower, RR 0.62, p = 0.007, high D levels 38 of 139 (27.3%), low D levels 48 of 109 (44.0%), NNT 6.0, vitamin D measured prior to COVID-19.
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risk of severe case, 34.8% lower, RR 0.65, p = 0.02, high D levels 31 of 115 (27.0%), low D levels 55 of 133 (41.4%), NNT 6.9, vitamin D measured on admission.
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| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Fatemi et al., 30 Nov 2021, prospective, Iran, peer-reviewed, 5 authors, study period 1 October, 2020 - 31 May, 2021.
Association of vitamin D deficiency with COVID-19 severity and mortality in Iranian people: a prospective observational study
Acute and Critical Care, doi:10.4266/acc.2021.00605
Background: As the coronavirus disease 2019 (COVID-19) pandemic continues to escalate, it is important to identify the prognostic factors related to increased mortality and disease severity. To assess the possible associations of vitamin D level with disease severity and survival, we studied 248 hospitalized COVID-19 patients in a single center in a prospective observational study from October 2020 to May 2021 in Tehran, Iran. Methods: Patients who had a record of their 25-hydroxyvitamin D level measured in the previous year before testing positive with COVID-19 were included. Serum 25-hydroxyvitamin D level was measured upon admission in COVID-19 patients. The associations between clinical outcomes of patients and 25-hydroxyvitamin D level were assessed by adjusting for potential confounders and estimating a multivariate logistic regression model.
Results: The median (interquartile range) age of patients was 60 years (44-74 years), and 53% were male. The median serum 25-hydroxyvitamin D level prior to admission decreased with increasing COVID-19 severity (P=0.009). Similar findings were obtained when comparing median serum 25-hydroxyvitamin D on admission between moderate and severe patients (P=0.014). A univariate logistic regression model showed that vitamin D deficiency prior to COVID-19 was associated with a significant increase in the odds of mortality (odds ratio, 2.01; P=0.041). The multivariate Cox model showed that vitamin D deficiency on admission was associated with a significant increase in risk for mortality (hazard ratio, 2.35; P=0.019). Conclusions: Based on our results, it is likely that deficient vitamin D status is associated with increased mortality in COVID-19 patients. Thus, evaluating vitamin D level in COVID-19 patients is warranted.
CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported.
AUTHOR CONTRIBUTIONS Conceptualization: AF, SHA, GE. Data curation: GE, SM. Formal analysis: SHA, GE, MN. Funding acquisition: AF, SHA, GE, MN. Methodology: AF, SHA, GE, SM. Project administration: GE. Visualization: AF, MN. Writing-original draft: AF, SHA, GE. Writing-review & editing: all authors.
References
Agier, Efenberger, Brzezińska-Błaszczyk, Cathelicidin impact on inflammatory cells, Cent Eur J Immunol
Aslan, Aslan, Özdemir, Letter to the editor: is vitamin d one of the key elements in COVID-19 days?, J Nutr Health Aging, doi:10.1007/s12603-020-1517-y
Bhatraju, Ghassemieh, Nichols, Kim, Jerome et al., COVID-19 in critically ill patients in the Seattle Region: case series, N Engl J Med, doi:10.1056/nejmoa2004500
Charoenngam, Holick, Immunologic effects of vitamin D on human health and disease, Nutrients, doi:10.3390/nu12072097
D'avolio, Avataneo, Manca, Cusato, Nicolò et al., 25-Hydroxyvitamin D concentrations are low-Acute and, Critical Care
Fatemi, Vitamin D deficiency and COVID-19 er in patients with positive PCR for SARS-CoV-2, Nutrients
Herr, Shaykhiev, Bals, The role of cathelicidin and defensins in pulmonary inflammatory diseases, Expert Opin Biol Ther, doi:10.1517/14712598.7.9.1449
Holick, Binkley, Bischoff-Ferrari, Gordon, Hanley et al., Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline, J Clin Endocrinol Metab, doi:10.1210/jc.2011-0385
Holick, The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention, Rev Endocr Metab Disord, doi:10.1007/s11154-017-9424-1
Ilie, Stefanescu, Smith, The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality, Aging Clin Exp Res, doi:10.1007/s40520-020-01570-8
Infante, Buoso, Pieri, Lupisella, Nuccetelli et al., Low vitamin d status at admission as a risk factor for poor survival in hospitalized patients with COVID-19: an Italian retrospective study, J Am Coll Nutr, doi:10.1080/07315724.2021.1877580
Jain, Chaurasia, Sengar, Singh, Mahor et al., Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers, Sci Rep, doi:10.1038/s41598-020-77093-z
Liu, Sun, Wang, Zhang, Zhao et al., Low vitamin D status is associated with coronavirus disease 2019 outcomes: a systematic review and meta-analysis, Int J Infect Dis, doi:10.1016/j.ijid.2020.12.077
Luo, Liao, Shen, Li, Cheng, Vitamin D deficiency is associated with COVID-19 Incidence and disease severity in Chinese people, doi:10.1093/jn/nxaa332
Mahdavi, A brief review of interplay between vitamin D and angiotensin-converting enzyme 2: Implications for a potential treatment for COVID-19, Rev Med Virol
Meltzer, Best, Zhang, Vokes, Arora et al., Association of vitamin D status and other clinical characteristics with COVID-19 test results, JAMA Netw Open, doi:10.1001/jamanetworkopen.2020.19722
Murai, Fernandes, Sales, Pinto, Goessler et al., Effect of a single high dose of vitamin D3 on hospital length of stay in patients with moderate to severe COVID-19: a randomized clinical trial, JAMA, doi:10.1001/jama.2020.26848
Pereira, Damascena, Azevedo, De Almeida Oliveira, Da Mota, Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis, Crit Rev Food Sci Nutr, doi:10.1080/10408398.2020.1841090
Pinheiro, Fabbri, Infante, Cytokine storm modulation in COVID-19: a proposed role for vitamin D and DPP-4 inhibitor combination therapy (VIDPP-4i), Immunotherapy, doi:10.2217/imt-2020-0349
Radujkovic, Hippchen, Tiwari-Heckler, Dreher, Boxberger, Vitamin D deficiency and outcome of COVID-19 patients, Nutrients, doi:10.3390/nu12092757
Tehrani, Khabiri, Moradi, Mosavat, Khabiri, Evaluation of vitamin D levels in COVID-19 patients referred to Labafinejad hospital in Tehran and its relationship with disease severity and mortality, Clin Nutr ESPEN, doi:10.1016/j.clnesp.2021.01.014
Weiss, Murdoch, Clinical course and mortality risk of severe COVID-19, Lancet, doi:10.1016/s0140-6736(20)30633-4
Worldometer, COVID-19 corona virus pandemic
Yisak, Ewunetei, Kefale, Mamuye, Teshome et al., Effects of vitamin D on COVID-19 infection and prognosis: a systematic review, Risk Manag Healthc Policy, doi:10.2147/rmhp.s291584
Zdrenghea, Makrinioti, Bagacean, Bush, Johnston et al., Vitamin D modulation of innate immune responses to respiratory viral infections, Rev Med Virol, doi:10.1002/rmv.1909
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"abstract": "<jats:p>Background: As the coronavirus disease 2019 (COVID-19) pandemic continues to escalate, it is important to identify the prognostic factors related to increased mortality and disease severity. To assess the possible associations of vitamin D level with disease severity and survival, we studied 248 hospitalized COVID-19 patients in a single center in a prospective observational study from October 2020 to May 2021 in Tehran, Iran. Methods: Patients who had a record of their 25-hydroxyvitamin D level measured in the previous year before testing positive with COVID-19 were included. Serum 25-hydroxyvitamin D level was measured upon admission in COVID-19 patients. The associations between clinical outcomes of patients and 25-hydroxyvitamin D level were assessed by adjusting for potential confounders and estimating a multivariate logistic regression model. Results: The median (interquartile range) age of patients was 60 years (44–74 years), and 53% were male. The median serum 25-hydroxyvitamin D level prior to admission decreased with increasing COVID-19 severity (P=0.009). Similar findings were obtained when comparing median serum 25-hydroxyvitamin D on admission between moderate and severe patients (P=0.014). A univariate logistic regression model showed that vitamin D deficiency prior to COVID-19 was associated with a significant increase in the odds of mortality (odds ratio, 2.01; P=0.041). The Multivariate Cox model showed that vitamin D deficiency on admission was associated with a significant increase in risk for mortality (hazard ratio, 2.35; P=0.019).Conclusions: Based on our results, it is likely that deficient vitamin D status is associated with increased mortality in COVID-19 patients. Thus, evaluating vitamin D level in COVID-19 patients is warranted.</jats:p>",
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