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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'abstract': '<jats:title>Abstract</jats:title><jats:p>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\xa0weeks. Participants were COVID-19 patients of age group 30–60\xa0'
'years admitted during the study period of 6\xa0weeks. 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\u2009±\u20096.21 in Group A and 14.35\u2009±\u20095.79 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\u2009±\u20096.17 vs 12.18\u2009±\u20094.29; Serum ferritin 319.17\u2009±\u200938.21\xa0'
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'11.87\u2009±\u20093.15. 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.</jats:p>',
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'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'}
