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The association between vitamin D intake with inflammatory and biochemical indices and mortality in critically ill patients with COVID‐19: A case‐control study

Gholamalizadeh et al., Immunity, Inflammation and Disease, doi:10.1002/iid3.844

Apr 2023

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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.

Lower risk for mortality, ICU admission, hospitalization, progression, recovery, cases, and viral clearance.

No treatment is 100% effective. Protocols combine complementary and synergistic treatments. ^* >10% efficacy in meta analysis with ≥3 clinical studies.

4,000+ studies for 60+ treatments. c19early.org

Case control study with 200 critical COVID-19 patients in Iran, showing lower mortality with higher vitamin D supplement intake. Authors do not provide enough information to assess confounding. Authors indicate that treatment was based on the opinion of the treating physician, and include only patients with at least one week in the ICU, however patients that die may have lower vitamin D supplement duration because they are no longer alive.

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: survival bias may significantly affect results.

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risk of death, 68.8% lower, OR 0.31, p = 0.04, inverted to make OR<1 favor treatment, model 3, RR approximated with OR.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Gholamalizadeh et al., 26 Apr 2023, Iran, peer-reviewed, 13 authors. Contact: doaei@gums.ac.ir, profmeakbari@gmail.com.

This Paper Vitamin D All

The association between vitamin D intake with inflammatory and biochemical indices and mortality in critically ill patients with COVID‐19: A case‐control study

Maryam Gholamalizadeh, Faezeh Rabbani, Mina Ahmadzadeh, Azadeh Hajipour, Hayehe Musavi, Khadijeh Abbasi Mobarakeh, Zahra Salimi, Bojlul Bahar, Zahra Mahmoodi, Somayeh Gholami, Samaneh Mirzaei Dahka, Saeid Doaei, Mokammad Esmail Akbari

Immunity, Inflammation and Disease, doi:10.1002/iid3.844

Background: The coronavirus disease-2019 (COVID-19) has become a worldwide health issue with widespread hospitalization and dependence on the intensive care unit (ICU). Vitamin D has a key role in modulating immune cells and modulating the inflammatory responses. This study aimed to investigate the association of vitamin D supplementation with inflammatory, biochemical, and mortality indices in critically ill patients with COVID-19. Methods: This case-control study was conducted on critically ill COVID-19 patients hospitalized in the ICU including the survived >30 day patients as the case group and dead patients as the control group. The status of vitamin D

CONFLICT OF INTEREST STATEMENT The authors declare no conflict of interest. ETHICS STATEMENT This study was approved by the Institutional Review Board at Shahid-Beheshti University of Medical Sciences (code: IR.SBMU.CRC.REC.1399.031). All patients signed an informed consent form at baseline. Institutional consent forms were used in this study.

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