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Chronic diseases, chest computed tomography, and laboratory tests as predictors of severe respiratory failure and death in elderly Brazilian patients hospitalized with COVID-19: a prospective cohort study

Junior et al., BMC Geriatrics, doi:10.1186/s12877-022-02776-3
Feb 2022  
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Mortality 22% treatment Improvement Relative Risk Progression 31% treatment Ventilation 84% levels Vitamin D for COVID-19  Junior et al.  Prophylaxis Is prophylaxis with vitamin D beneficial for COVID-19? Prospective study of 201 patients in Brazil Lower progression with vitamin D (not stat. sig., p=0.26) c19early.org Junior et al., BMC Geriatrics, February 2022 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 81 treatments. c19early.org
Prospective study of 201 COVID+ hospitalized adults in Brazil, mean age 73, showing a lower risk of mortality and respiratory failure with vitamin D supplementation in unadjusted results, without statistical significance, and a higher risk of progression to mechanical ventilation with vitamin D levels <40ng/dl.
This is the 70th of 122 COVID-19 controlled studies for vitamin D, which collectively show efficacy with p<0.0000000001 (1 in 587 sextillion).
30 studies are RCTs, which show efficacy with p=0.0000032.
risk of death, 22.1% lower, RR 0.78, p = 0.61, treatment 8 of 113 (7.1%), control 8 of 88 (9.1%), NNT 50, excluded in exclusion analyses: unadjusted results with no group details.
risk of progression, 30.8% lower, RR 0.69, p = 0.26, treatment 16 of 113 (14.2%), control 18 of 88 (20.5%), NNT 16, respiratory failure, excluded in exclusion analyses: unadjusted results with no group details.
risk of mechanical ventilation, 84.4% lower, OR 0.16, p = 0.03, cutoff 40ng/dl, inverted to make OR<1 favor high D levels (≥40ng/dl), risk of mechanical ventilation for vitamin D levels >40ng/ml, RR approximated with OR, outcome based on serum levels.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Junior et al., 17 Feb 2022, prospective, Brazil, peer-reviewed, 6 authors, dosage not specified.
This PaperVitamin DAll
Chronic diseases, chest computed tomography, and laboratory tests as predictors of severe respiratory failure and death in elderly Brazilian patients hospitalized with COVID-19: a prospective cohort study
Alberto Frisoli Junior, Elaine Azevedo, Angela Tavares Paes, Eliene Lima, João Carlos Campos Guerra, Sheila Jean Mc Neill Ingham
BMC Geriatrics, doi:10.1186/s12877-022-02776-3
Background: The primary risk factors for severe respiratory failure and death in the elderly hospitalized with COVID-19 remain unclear. Objective: To determine the association of chronic diseases, chest computed tomography (CT), and laboratory tests with severe respiratory failure and mortality in older adults hospitalized with COVID-19. Method: This was a prospective cohort with 201 hospitalized older adults with COVID-19. Chronic diseases, chest CT, laboratory tests, and other data were collected within the first 48 h of hospitalization. Outcomes were progression to severe respiratory failure with the need of mechanical ventilation (SRF/MV) and death. Results: The mean age was 72.7 ± 9.2 years, and 63.2% were men. SRF/MV occurred in 16.9% (p < 0.001), and death occurred in 8%. In the adjusted regression analyses, lung involvement over 50% [odds ratio (OR): 3.09 (1.03-9.28; 0.043)], C-reactive protein (CRP) > 80 ng/mL [OR: 2.97 (0.99-8.93; 0.052)], Vitamin D < 40 ng/mL [OR: 6.41 (1.21-33.88; 0.029)], and hemoglobin < 12 g/mL ; 0.020)] were independent predictors for SFR/MV, while chronic atrial fibrillation ; 0.001)], cancer history 0.026)] and IL-6 > 40 pg/ mL [OR:10.01 (1.66-60.13; 0.012)] were independent predictors of death. Conclusion: In hospitalized older adults with COVID-19, tomographic pulmonary involvement > 50%, anemia, vitamin D below 40 ng/mL, and CRP above 80 mg/L were independent risk factors for progression to SRF/MV. The presence of chronic atrial fibrillation, previous cancer, IL-6 > 40 pg/mL, and anemia were independent predictors of death.
Abbreviations 25(OH)D: 25-hydroxyvitamin-D; ALT: alanine transaminase; AST: aspartate aminotransferase; CKD: chronic kidney disease (non-hemodialysis); Creat: creatinine; CRP: C-reactive protein; CT: computed tomography; ESRD: end-stage renal disease (on HD); HD: hemodialysis; Hb: hemoglobin; ICU: intensive care units; IL: interleukin; LDH: lactate dehydrogenase; Myo: myoglobin; SRF/MV: severe respiratory failure with the need of mechanical ventilation; TLeuc: total leucocytes; TLymp: total lymphocytes; TNF: tumor necrosis factor. Authors' contributions Accordance statement and authors' specific areas of contributions: Statements; All authors confirm authorship and participation in the preparation of the manuscript. This material has not been previously published, is not presently under consideration for publication elsewhere, nor will it be submitted elsewhere while it is under reviewed by your Journal. No other submissions or publications include material that is largely duplicative of that presented in the manuscript or derived from the same subjects. If accepted, the paper will not be published elsewhere in the same form, in English or in any other language, including electronically, without the written consent of the copyright holder. No references were blacked-out. The authors declare that they agree with all the statements presented in this manuscript. This manuscript had been read and approved by all authors. Authors' specific areas of contributions; AFJ, EA, SJMI,..
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Available ' 'from: ' 'https://valor.globo.com/brasil/noticia/2020/07/15/ibge-populacao-sem-instrucao-cai-e-tempo-medio-de-estudo-atinge-94-anos.ghtml'}, { 'issue': '7', 'key': '2776_CR19', 'doi-asserted-by': 'publisher', 'first-page': '1021', 'DOI': '10.1515/cclm-2020-0369', 'volume': '58', 'author': 'BM Henry', 'year': '2020', 'unstructured': 'Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, ' 'biochemical and immune biomarker abnormalities associated with severe ' 'illness and mortality in coronavirus disease 2019 (COVID-19): a ' 'meta-analysis. Clin Chem Lab Med. 2020;58(7):1021–8 Available from: ' 'https://www.degruyter.com/document/doi/10.1515/cclm-2020-0369/html.', 'journal-title': 'Clin Chem Lab Med'}, { 'issue': '3', 'key': '2776_CR20', 'doi-asserted-by': 'publisher', 'first-page': '1478', 'DOI': '10.1002/jmv.26444', 'volume': '93', 'author': 'Z Tao', 'year': '2021', 'unstructured': 'Tao Z, Xu J, Chen W, Yang Z, Xu X, Liu L, et al. Anemia is associated ' 'with severe illness in COVID-19: a retrospective cohort study. J Med ' 'Virol. 2021;93(3):1478–88 Available from: ' 'https://onlinelibrary.wiley.com/doi/10.1002/jmv.26444.', 'journal-title': 'J Med Virol'}, { 'issue': '9', 'key': '2776_CR21', 'doi-asserted-by': 'publisher', 'first-page': '593', 'DOI': '10.21037/atm-20-3391', 'volume': '8', 'author': 'C Wang', 'year': '2020', 'unstructured': 'Wang C, Deng R, Gou L, Fu Z, Zhang X, Shao F, et al. Preliminary study ' 'to identify severe from moderate cases of COVID-19 using combined ' 'hematology parameters. 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All participants or caregivers / family members ' 'signed the Informed Consent Form (ICF). The signing was performed in person by ' 'a member of the study team or through an electronic document sent to the ' 'participant, after a phone call in which the ICF was read and explained by a ' 'member of the study team. The project and Informed Consent Form (ICF) were ' 'approved by the Ethics Committee of the Hospital Israelita Albert Einstein and ' 'of Plataforma Brasil under the numbers: 4.082.096 e 4.186.636 .', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'Not applicable.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare that they have no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '132'}
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