The Impact of Serum Levels of Vitamin D3 and Its Metabolites on the Prognosis and Disease Severity of COVID-19
Khojah et al.,
The Impact of Serum Levels of Vitamin D3 and Its Metabolites on the Prognosis and Disease Severity of COVID-19,
Nutrients, doi:10.3390/nu14245329
Analysis of 103 COVID-19 patients and 50 healthy controls in Saudi Arabia, showing significantly lower vitamin D and vitamin D metabolite levels in COVID-19 patients, and correlations between vitamin D levels and ACE2 levels, IL-6, and NLR in COVID-19 patients.
Khojah et al., 15 Dec 2022, retrospective, Saudi Arabia, peer-reviewed, 5 authors, study period October 2020 - December 2021.
Contact:
shassan@taibahu.edu.sa (corresponding author).
Abstract: nutrients
Article
The Impact of Serum Levels of Vitamin D3 and Its Metabolites
on the Prognosis and Disease Severity of COVID-19
Hani M. J. Khojah 1 , Sameh A. Ahmed 2, * , Sultan S. Al-Thagfan 1 , Yaser M. Alahmadi 1
1
2
3
*
Citation: Khojah, H.M.J.; Ahmed,
S.A.; Al-Thagfan, S.S.; Alahmadi,
Y.M.; Abdou, Y.A. The Impact of
Serum Levels of Vitamin D3 and Its
Metabolites on the Prognosis and
Disease Severity of COVID-19.
Nutrients 2022, 14, 5329. https://
doi.org/10.3390/nu14245329
and Yasser A. Abdou 3
Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University,
Al Madinah Al Munawarah 30001, Saudi Arabia
Department of Pharmacognosy and Pharmaceutical Chemistry, College of Pharmacy, Taibah University,
Al Madinah Al Munawarah 30001, Saudi Arabia
Ohud Hospital, Al Madinah Al Munawarah 42354, Saudi Arabia
Correspondence: shassan@taibahu.edu.sa; Tel.: +966-54-3110057
Abstract: Vitamin D is among the increasingly consumed dietary supplements during the COVID-19
pandemic. It plays a regulatory role in the immune system and moderates the renin–angiotensin
system, which is implicated in infection pathogenesis. However, the investigation of serum levels of
vitamin D3 forms and their relative ratios in COVID-19 patients is worth investigation to understand
the impacts of disease severity. Hence, we investigated the serum levels of vitamin D3 (cholecalciferol)
and its metabolites (calcifediol and calcitriol), in addition to their relative ratios and correlations with
angiotensin-converting enzyme 2 (ACE2), interleukin-6 (Il-6), and neutrophil–lymphocyte ratio (NLR)
in COVID-19 patients compared with healthy controls. Oropharyngeal specimens were collected
from the study subjects for polymerase chain reaction testing for COVID-19. Whole blood samples
were obtained for blood count and NLR testing, and sera were used for the analysis of the levels of
the vitamin and its metabolites, ACE2, and IL-6. We enrolled 103 patients and 50 controls. ACE2,
Il-6, and NLR were significantly higher in the patients group (72.37 ± 18.67 vs. 32.36 ± 11.27 U/L,
95.84 ± 25.23 vs. 2.76 ± 0.62 pg/mL, and 1.61 ± 0.30 vs. 1.07 ± 0.16, respectively). Cholecalciferol,
calcifediol, and calcitriol were significantly lower in patients (18.50 ± 5.36 vs. 29.13 ± 4.94 ng/mL,
14.60 ± 3.30 vs. 23.10 ± 3.02 ng/mL, and 42.90 ± 8.44 vs. 65.15 ± 7.11 pg/mL, respectively). However,
their relative ratios were normal in both groups. Levels of the vitamin and metabolites were strongly
positively, strongly negatively, and moderately negatively correlated with ACE2, Il-6, and NLR,
respectively. COVID-19 infection severity is associated with a significant decrease in vitamin D3 and
its metabolites in a parallel pattern, and with a significant increase in ACE2, Il-6, and NLR. Higher
levels of vitamin D and its metabolites are potentially protective against severe infection.
Academic Editor: Andrea Fabbri
Received: 21 November 2022
Accepted: 12 December 2022
Keywords: COVID-19; vitamin D; vitamin D3; cholecalciferol; calcifediol; calcitriol; angiotensinconverting enzyme 2; interleukin-6; NLR
Published: 15 December 2022
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