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Clinical comorbidities, characteristics, and outcomes of mechanically ventilated patients in the State of Michigan with SARS-CoV-2 pneumonia

Krishnan et al., Journal of Clinical Anesthesia, doi:10.1016/j.jclinane.2020.110005
Jul 2020  
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Mortality 19% Improvement Relative Risk Vitamin D  Krishnan et al.  LATE TREATMENT Is late treatment with vitamin D beneficial for COVID-19? Retrospective 152 patients in the USA Lower mortality with vitamin D (not stat. sig., p=0.42) c19early.org Krishnan et al., J. Clinical Anesthesia, Jul 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.
5,100+ studies for 109 treatments. c19early.org
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: 69% [47‑82%] lower risk vs. 39% [27‑49%] 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 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.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
Study covers zinc, vitamin D, vitamin C, and HCQ.
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.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Krishnan et al., 20 Jul 2020, retrospective, USA, peer-reviewed, 13 authors, dosage not specified.
This PaperVitamin DAll
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
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre -including this research content -immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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
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Late treatment
is less effective
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