A Study on Serum Vitamin D3 Level in Patients with Covid-19: A Cross-Sectional Study in Kolkata
Enamul Hossain, Sanjay K Mandal, Souvik Sarkar, Amrita Jha, Ranjan Mondal
National Journal of Medical Research, doi:10.55489/njmr.150220251070
Background: Coronavirus disease (COVID-19) is a global pandemic caused by SARS-CoV-2. Vitamin D has immunomodulatory and anti-inflammatory properties, potentially influencing the disease course. This study assessed the prevalence of 25(OH) vitamin D deficiency in COVID-19 patients and its association with disease severity in the Indian population. Methodology: A hospital-based cross-sectional study was conducted at Medical College, Kolkata, including 100 RT-PCR-confirmed moderate and severe COVID-19 patients. Disease severity was categorized based on oxygen saturation. Serum 25-Hydroxy vitamin D levels were measured on admission, along with other hematological and biochemical parameters. High-resolution CT scans were performed to assess pulmonary involvement. Results: Vitamin D insufficiency and deficiency were observed in 18% and 67% of patients, respectively. Deficiency was more prevalent in severe cases (82.97%) than moderate cases (52.83%). The mean vitamin D levels in moderate and severe disease groups were 23.23±8.74 and 17.17±8.09 ng/ml, respectively. A significant association was found between vitamin D deficiency and COVID-19 severity (P = 0.006). The vitamin D cutoff for predicting severe disease was 18.57 ng/dl.
Conclusion: Vitamin D deficiency is strongly associated with severe COVID-19 in the Indian population. Low vitamin D levels may predict disease severity, suggesting supplementation as a potential preventive strategy.
Conflict of Interest: The authors have declared that no conflicts of interest exist.
References
Hamming, Timens, Bulthuis, Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis, J Pathol,
doi:10.1002/path.1570PMid:15141377
Lemire, Adams, Sakai, Jordan, 1 alpha, 25-dihydroxyvitamin D3 suppresses proliferation and immunoglobulin production by normal human peripheral blood mononuclear cells, The Journal of clinical investigation,
doi:10.1172/JCI111465PMid:6611355PMCid:PMC370520
Luo, Liao, Shen, Li, Cheng, Vitamin D deficiency is associated with COVID-19 incidence and disease severity in Chinese people, The Journal of nutrition,
doi:10.1093/jn/nxaa332PMid:33188401
Radujkovic, Hippchen, Tiwari-Heckler, Vitamin D deficiency and outcome of COVID-19 patients, Nutrients,
doi:10.3390/nu12092757
Teama, Abdelhakam, Elmohamadi, Badr, Vitamin D deficiency as a predictor of severity in patients with COVID-19 infection, Science Progress,
doi:10.1177/00368504211036854
DOI record:
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"abstract": "<jats:p>Background: Coronavirus disease (COVID-19) is a global pandemic caused by SARS-CoV-2. Vitamin D has immunomodulatory and anti-inflammatory properties, potentially influencing the disease course. This study assessed the prevalence of 25(OH) vitamin D deficiency in COVID-19 patients and its association with disease severity in the Indian population.\nMethodology: A hospital-based cross-sectional study was conducted at Medical College, Kolkata, including 100 RT-PCR-confirmed moderate and severe COVID-19 patients. Disease severity was categorized based on oxygen saturation. Serum 25-Hydroxy vitamin D levels were measured on admission, along with other hematological and biochemical parameters. High-resolution CT scans were performed to assess pulmonary involvement.\nResults: Vitamin D insufficiency and deficiency were observed in 18% and 67% of patients, respectively. Deficiency was more prevalent in severe cases (82.97%) than moderate cases (52.83%). The mean vitamin D levels in moderate and severe disease groups were 23.23±8.74 and 17.17±8.09 ng/ml, respectively. A significant association was found between vitamin D deficiency and COVID-19 severity (P = 0.006). The vitamin D cutoff for predicting severe disease was 18.57 ng/dl.\nConclusion: Vitamin D deficiency is strongly associated with severe COVID-19 in the Indian population. Low vitamin D levels may predict disease severity, suggesting supplementation as a potential preventive strategy.</jats:p>",
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