Vitamin D Insufficiency is Prevalent in Severe COVID-19

Lau et al., medRxiv, doi:10.1101/2020.04.24.20075838, Apr 2020

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Vitamin D for COVID-19

8th treatment shown to reduce risk in October 2020, now with p < 0.00000000001 from 125 studies, recognized in 18 countries.

Lower risk for mortality, ICU, hospitalization, progression, recovery, cases, and viral clearance.

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Analysis of 20 hospitalized COVID-19 patients, 13 requiring ICU admission. 84.6% of the ICU patients had low vitamin D levels versus 57.1% of the non-ICU patients.

This is the 1st of 218 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 25,894,433,917 vigintillion).

Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved. Low-cost treatments were excluded, reducing the probability of treatment—especially early—due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.

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risk of ICU admission, 45.0% lower, RR 0.55, p = 0.29, high D levels 2 of 5 (40.0%), low D levels 11 of 15 (73.3%), NNT 3.0, >30ng/mL.

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1. c19early.org, c19early.org/soc/usa.html.c19early.org/soc/usa.html.

Lau et al., 28 Apr 2020, retrospective, USA, preprint, 7 authors.

This Paper Vitamin D All

Abstract: medRxiv preprint doi: https://doi.org/10.1101/2020.04.24.20075838; this version posted April 28, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. Vitamin D insufficiency is prevalent in severe COVID-19 Frank H. Lau, MD, FACS1, Rinku Majumder, PhD2, Radbeh Torabi, MD1, Fouad Saeg, BS3, Ryan Hoffman, BS4, Jeffrey D. Cirillo, PhD5, Patrick Greiffenstein, MD, FACS1 Affiliations: 1. Department of Surgery, Louisiana State University Health Sciences Center New Orleans (LSUHSC-NO) 2. Department of Biochemistry, LSUHSC-NO 3. Tulane School of Medicine 4. LSUHSC-NO School of Medicine 5. Department of Microbial Pathogenesis and Immunology, Texas A&M College of Medicine Corresponding Author: Dr. Frank H. Lau, MD, FACS; Department of Surgery, Louisiana State University Health Sciences Center New Orleans, 1542 Tulane Ave, 7th Floor, New Orleans, LA 70112; email: flau@lsuhsc.edu; phone: (504) 412-1240 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.04.24.20075838; this version posted April 28, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.

DOI record: { "DOI": "10.1101/2020.04.24.20075838", "URL": "http://dx.doi.org/10.1101/2020.04.24.20075838", "abstract": "BackgroundCOVID-19 is a major pandemic that has killed more than 196,000 people. The COVID-19 disease course is strikingly divergent. Approximately 80-85% of patients experience mild or no symptoms, while the remainder develop severe disease. The mechanisms underlying these divergent outcomes are unclear. Emerging health disparities data regarding African American and homeless populations suggest that vitamin D insufficiency (VDI) may be an underlying driver of COVID-19 severity. To better define the VDI-COVID-19 link, we determined the prevalence of VDI among our COVID-19 intensive care unit (ICU) patients.MethodsIn an Institutional Review Board approved study performed at a single, tertiary care academic medical center, the medical records of COVID-19 patients were retrospectively reviewed. Subjects were included for whom serum 25-hydroxycholecalcifoerol (25OHD) levels were determined. COVID-19-relevant data were compiled and analyzed. We determined the frequency of VDI among COVID-19 patients to evaluate the likelihood of a VDI-COVID-19 relationship.ResultsTwenty COVID-19 patients with serum 25OHD levels were identified; 65.0% required ICU admission.The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI. Coagulopathy was present in 62.5% of ICU COVID-19 patients, and 92.3% were lymphocytopenic.ConclusionsVDI is highly prevalent in severe COVID-19 patients. VDI and severe COVID-19 share numerous associations including hypertension, obesity, male sex, advanced age, concentration in northern climates, coagulopathy, and immune dysfunction. Thus, we suggest that prospective, randomized controlled studies of VDI in COVID-19 patients are warranted.", "accepted": { "date-parts": [ [ 2020, 4, 28 ] ] }, "author": [ { "ORCID": "http://orcid.org/0000-0001-7061-4209", "affiliation": [], "authenticated-orcid": false, "family": "Lau", "given": "Frank H.", "sequence": "first" }, { "affiliation": [], "family": "Majumder", "given": "Rinku", "sequence": "additional" }, { "affiliation": [], "family": "Torabi", "given": "Radbeh", "sequence": "additional" }, { "affiliation": [], "family": "Saeg", "given": "Fouad", "sequence": "additional" }, { "affiliation": [], "family": "Hoffman", "given": "Ryan", "sequence": "additional" }, { "affiliation": [], "family": "Cirillo", "given": "Jeffrey D.", "sequence": "additional" }, { "affiliation": [], "family": "Greiffenstein", "given": "Patrick", "sequence": "additional" } ], "container-title": [], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2020, 4, 28 ] ], "date-time": "2020-04-28T20:55:17Z", "timestamp": 1588107317000 }, "deposited": { "date-parts": [ [ 2020, 12, 6 ] ], "date-time": "2020-12-06T18:55:29Z", "timestamp": 1607280929000 }, "group-title": "Infectious Diseases (except HIV/AIDS)", "indexed": { "date-parts": [ [ 2024, 2, 9 ] ], "date-time": "2024-02-09T15:44:53Z", "timestamp": 1707493493955 }, "institution": [ { "name": "medRxiv" } ], "is-referenced-by-count": 79, "issued": { "date-parts": [ [ 2020, 4, 28 ] ] }, "link": [ { "URL": "https://syndication.highwire.org/content/doi/10.1101/2020.04.24.20075838", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "246", "original-title": [], "posted": { "date-parts": [ [ 2020, 4, 28 ] ] }, "prefix": "10.1101", "published": { "date-parts": [ [ 2020, 4, 28 ] ] }, "publisher": "Cold Spring Harbor Laboratory", "reference": [ { "DOI": "10.1001/jama.2020.2648", "doi-asserted-by": "publisher", "key": "2020120610550786000_2020.04.24.20075838v1.1" }, { "key": "2020120610550786000_2020.04.24.20075838v1.2", "unstructured": "Turk, S. 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M. Vitamin D and Influenza—Prevention or Therapy? Int J Mol Sci 19, (2018)." } ], "reference-count": 33, "references-count": 33, "relation": {}, "resource": { "primary": { "URL": "http://medrxiv.org/lookup/doi/10.1101/2020.04.24.20075838" } }, "score": 1, "short-title": [], "source": "Crossref", "subtitle": [], "subtype": "preprint", "title": "Vitamin D insufficiency is prevalent in severe COVID-19", "type": "posted-content" }

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