Retrospective 152 mechanically ventilated patients in the USA showing unadjusted lower mortality with vitamin C, vitamin D, HCQ, and zinc treatment, statistically significant only for vitamin C.
Cholecalciferol was used in this study.
Meta analysis shows that late stage treatment with
calcitriol / calcifediol (or
paricalcitol, alfacalcidol, etc.) is more effective than
cholecalciferol:
65% [41‑79%] lower risk vs.
38% [25‑49%] lower risk.
Cholecalciferol requires two hydroxylation steps to become activated - first
in the liver to calcifediol, then in the kidney to calcitriol. Calcitriol,
paricalcitol, and alfacalcidol are active vitamin D analogs that do not
require conversion. This allows them to have more rapid onset of action
compared to cholecalciferol. The time delay for cholecalciferol to increase
serum calcifediol levels can be 2-3 days, and the delay for converting
calcifediol to active calcitriol can be up to 7 days.
This is the
2nd of 115 COVID-19 controlled studies for vitamin D, which collectively show efficacy with
p<0.0000000001 (1 in 30 sextillion).
27 studies are RCTs, which show efficacy with
p=0.00002.
This study is excluded in the after exclusion results of meta
analysis:
unadjusted results with no group details.
|
risk of death, 19.0% lower, RR 0.81, p = 0.42, treatment 8 of 16 (50.0%), control 84 of 136 (61.8%), NNT 8.5.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Krishnan et al., 20 Jul 2020, retrospective, USA, peer-reviewed, 13 authors, dosage not specified.
Clinical comorbidities, characteristics, and outcomes of mechanically ventilated patients in the State of Michigan with SARS-CoV-2 pneumonia
Sandeep Krishnan, Kinjal Patel, Ronak Desai, Anupam Sule, Peter Paik, Ashley Miller, Alicia Barclay, Adam Cassella, Jon Lucaj, Yvonne Royster, Joffer Hakim, Zulfiqar Ahmed, Farhad Ghoddoussi
Journal of Clinical Anesthesia, doi:10.1016/j.jclinane.2020.110005
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References
Huang, Wang, Li, Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China, Lancet
Richardson, Hirsch, Narasimhan, Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area, JAMA
Sandeep Krishnan A,B,C, Patel D,E, Desai D,E , Anupam Sule F,G, Paik, Miller et al., None
Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet
