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Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers

Jain et al., Nature, doi:10.1038/s41598-020-77093-z
Nov 2020  
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Mortality 85% Improvement Relative Risk ICU admission 95% Vitamin D for COVID-19  Jain et al.  Sufficiency Are vitamin D levels associated with COVID-19 outcomes? Prospective study of 154 patients in India Lower mortality (p=0.0014) and ICU admission (p<0.0001) c19early.org Jain et al., Nature, November 2020 Favorsvitamin D Favorscontrol 0 0.5 1 1.5 2+
Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
 
*, now with p < 0.00000000001 from 122 studies, recognized in 9 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19early.org
Prospective study of 91 asymptomatic and 63 ICU patients showing significantly higher vitamin D deficiency in the ICU patients (97% vs. 33%).
This is the 28th of 199 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 835,162 vigintillion).
risk of death, 85.2% lower, RR 0.15, p = 0.001, high D levels 2 of 64 (3.1%), low D levels 19 of 90 (21.1%), NNT 5.6, >20ng/mL.
risk of ICU admission, 95.4% lower, RR 0.05, p < 0.001, high D levels 2 of 64 (3.1%), low D levels 61 of 90 (67.8%), NNT 1.5, >20ng/mL.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Jain et al., 19 Nov 2020, prospective, India, peer-reviewed, 6 authors.
This PaperVitamin DAll
Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers
Anshul Jain, Rachna Chaurasia, Narendra Singh Sengar, Mayank Singh, Sachin Mahor, Sumit Narain
Scientific Reports, doi:10.1038/s41598-020-77093-z
COVID-19 is characterized by marked variability in clinical severity. Vitamin D had recently been reviewed as one of the factors that may affect the severity in COVID-19. The objective of current study is to analyze the vitamin D level in COVID-19 patients and its impact on the disease severity. After approval from Ethics Committee, M.L.B Medical College the current study was undertaken as continuous prospective observational study of 6 weeks. Participants were COVID-19 patients of age group 30-60 years admitted during the study period of 6 weeks. Study included either asymptomatic COVID-19 patients (Group A) or severely ill patients requiring ICU admission (Group B). Serum concentration of 25 (OH)D, were measured along with serum IL-6; TNFα and serum ferritin. Standard statistical analysis was performed to analyze the differences. Current Study enrolled 154 patients, 91 in Group A and 63 patients in Group B. The mean level of vitamin D (in ng/mL) was 27.89 ± 6.21 in Group A and 14.35 ± 5.79 in Group B, the difference was highly significant. The prevalence of vitamin D deficiency was 32.96% and 96.82% respectively in Group A and Group B. Out of total 154 patients, 90 patients were found to be deficient in vitamin D (Group A: 29; Group B: 61). Serum level of inflammatory markers was found to be higher in vitamin D deficient COVID-19 patients viz. IL-6 level (in pg/mL) 19.34 ± 6.17 vs 12.18 ± 4.29; Serum ferritin 319.17 ± 38.21 ng/mL vs 186.83 ± 20.18 ng/ mL; TNFα level (in pg/mL) 13.26 ± 5.64 vs 11.87 ± 3.15. The fatality rate was high in vitamin D deficient (21% vs 3.1%). Vitamin D level is markedly low in severe COVID-19 patients. Inflammatory response is high in vitamin D deficient COVID-19 patients. This all translates into increased mortality in vitamin D deficient COVID-19 patients. As per the flexible approach in the current COVID-19 pandemic authors recommend mass administration of vitamin D supplements to population at risk for COVID-19. In December 2019, several cases of pneumonia with unknown etiology reported in Wuhan, Hubei Province, China 1,2 . The disease spread quickly to other provinces of China and overseas. On 7 January 2020, a novel coronavirus was identified in the throat swab sample of one such patient and later declared to be the etiologic virus and was subsequently named as 2019nCoV by World Health Organization (WHO) 3 . On worsening of the situation WHO declared the outbreak as the public health emergency of international concern (PHEIC). In February 2020, WHO provided a nomenclature to the epidemic disease caused by SARS-CoV-2 as coronavirus disease 2019 (COVID-19) 4 . As on 12th August 2020 there are more than 20 million cases worldwide 5 , so for now it's almost impossible to contain the disease spread and focus is diverting towards better treatment and prevention of factors that enhance the severity of COVID-19. COVID-19 is characterized by its high infectivity and marked variability in clinical severity, of which..
Author contributions Competing interests The authors declare no competing interests.
References
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Argyropoulos, Association of initial viral load in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with outcome and symptoms, Am. J. Pathol, doi:10.1016/j.ajpath.2020.07.001
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Cardoso, Pereira, Native vitamin D in pre-dialysis chronic kidney disease, Nefrologia, doi:10.1016/j.nefro.2018.07.004
Cascella, Evaluation and Treatment Coronavirus (COVID-19)
Chen, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Lancet, doi:10.1016/S0140-6736(20)30211-7
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Holick, Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline [published correction appears in, J Clin Endocrinol Metab
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Kamboj, Dwivedi, Toteja, Prevalence of hypovitaminosis D in India & way forward, Indian J. Med. Res, doi:10.4103/ijmr.IJMR_1807_18
Laird, Rhodes, Kenny, Vitamin D and inflammation: potential implications for severity of covid-19, Ir. Med. J
Latz, Blood type and outcomes in patients with COVID-19, Ann. Hematol, doi:10.1007/s00277-020-04169-1
Magro, SARS-CoV-2 and COVID-19: is interleukin-6 (IL-6) the "culprit lesion" of ARDS onset? What is there besides Tocilizumab?, Cytokine X, doi:10.1016/j.cytox.2020.100029
Martineau, Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data, BMJ
Nile, COVID-19: pathogenesis, cytokine storm and therapeutic potential of interferons, Cytokine Growth Factor Rev, doi:10.1016/j.cytogfr.2020.05.002
Prietl, Treiber, Piber, Amrein, Vitamin D and immune function, Nutrients
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Xu, Vitamin D alleviates lipopolysaccharide-induced acute lung injury via regulation of the renin-angiotensin system, Mol. Med. Rep, doi:10.3892/mmr.2017.7546
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Res.'}, { 'issue': '5', 'key': '77093_CR29', 'doi-asserted-by': 'publisher', 'first-page': '7432', 'DOI': '10.3892/mmr.2017.7546', 'volume': '16', 'author': 'J Xu', 'year': '2017', 'unstructured': 'Xu, J. et al. Vitamin D alleviates lipopolysaccharide-induced acute lung ' 'injury via regulation of the renin-angiotensin system. Mol. Med. Rep. ' '16(5), 7432–7438. https://doi.org/10.3892/mmr.2017.7546 (2017).', 'journal-title': 'Mol. Med. Rep.'}, { 'key': '77093_CR30', 'doi-asserted-by': 'publisher', 'first-page': '10', 'DOI': '10.1016/j.nfs.2020.06.001', 'volume': '20', 'author': 'HK Biesalski', 'year': '2020', 'unstructured': 'Biesalski, H. K. Vitamin D deficiency and co-morbidities in COVID-19 ' 'patients: a fatal relationship?. Nfs J. 20, 10–21. ' 'https://doi.org/10.1016/j.nfs.2020.06.001 (2020).', 'journal-title': 'Nfs J.'}, { 'issue': '5', 'key': '77093_CR31', 'first-page': '81', 'volume': '113', 'author': 'E Laird', 'year': '2020', 'unstructured': 'Laird, E., Rhodes, J. & Kenny, R. A. Vitamin D and inflammation: ' 'potential implications for severity of covid-19. Ir. Med. J. 113(5), 81 ' '(2020).', 'journal-title': 'Ir. Med. J.'}], 'container-title': 'Scientific Reports', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.nature.com/articles/s41598-020-77093-z.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.nature.com/articles/s41598-020-77093-z', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.nature.com/articles/s41598-020-77093-z.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 12, 6]], 'date-time': '2022-12-06T23:25:14Z', 'timestamp': 1670369114000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.nature.com/articles/s41598-020-77093-z'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2020, 11, 19]]}, 'references-count': 31, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2020, 12]]}}, 'alternative-id': ['77093'], 'URL': 'http://dx.doi.org/10.1038/s41598-020-77093-z', 'relation': {}, 'ISSN': ['2045-2322'], 'subject': ['Multidisciplinary'], 'container-title-short': 'Sci Rep', 'published': {'date-parts': [[2020, 11, 19]]}, 'assertion': [ { 'value': '21 August 2020', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '23 October 2020', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '19 November 2020', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': 'The authors declare no competing interests.', 'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '20191'}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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