Bad Prognosis in Critical Ill Patients with COVID-19 during Short-Term ICU Stay regarding Vitamin D Levels
Lourdes Herrera-Quintana, Yenifer Gamarra-Morales, Héctor Vázquez-Lorente, Jorge Molina-López, José Castaño-Pérez, Juan Francisco Machado-Casas, Ramón Coca-Zúñiga, José Miguel Pérez-Villares, Elena Planells
Nutrients, doi:10.3390/nu13061988
Background and aims: Vitamin D inadequacy may be involved in the mechanisms of SARS-CoV-2 infection and in potential risk factors for disease propagation or control of coronavirus disease 2019 (COVID-19). This study assessed a short-term evolution of vitamin D status and its influence upon different clinical parameters in critically ill patients with COVID-19. Methods: A prospective analytical study in which 37 critically ill volunteers between 41 and 71 years of age with COVID-19 were evaluated at baseline and three days of intensive care unit (ICU) stay. 25-OH-D 3 and 25-OH-D 2 were analyzed by liquid chromatography-tandem mass spectrometry and total 25-OH-D levels were calculated as the sum of both. Results: All patients presented low 25-OH-D levels at baseline, decreasing total 25-OH-D (p = 0.011) mainly through 25-OH-D 2 (p = 0.006) levels during ICU stay. 25-OH-D 2 levels decreased a mean of 41.6% ± 89.6% versus 7.0% ± 23.4% for the 25-OH-D 3 form during the ICU stay. Patients who did not need invasive mechanical ventilation presented higher levels of 25-OH-D 2 at baseline and follow-up. Lower 25-OH-D and 25-OH-D 3 levels were associated with higher D-dimer at baseline (p = 0.003; p = 0.001) and at follow up (p = 0.029), higher procalcitonin levels (p = 0.002; p = 0.018) at follow up, and lower percentage lymphocyte counts (p = 0.044; p = 0.040) during ICU stay. Conclusions: Deficient vitamin D status in critical patients was established at the admission and further worsened after three days of stay. Lower vitamin D levels were related to key altered clinical and biochemical parameters on patients with SARS-CoV-2 infection. Given the different response of the 25-OH-D 3 and 25-OH-D 2 forms, it would be useful to monitor them on the evolution of the critically ill patient.
Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
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