Exploring the link between vitamin D and clinical outcomes in COVID-19
Prateek Lohia, Paul Nguyen, Neel Patel, Shweta Kapur
American Journal of Physiology-Endocrinology and Metabolism, doi:10.1152/ajpendo.00517.2020
The immunomodulating role of vitamin D might play a role in COVID-19 disease. We studied the association between vitamin D and clinical outcomes in COVID-19 patients. This is a retrospective cohort study on COVID-19 patients with documented vitamin D levels within the last year. Vitamin D levels were grouped as ! 20 ng/mL or < 20 ng/mL. Main outcomes were mortality, need for mechanical ventilation, new DVT or pulmonary embolism, and ICU admission. A total of 270 patients (mean ± SD) age, 63.81 (14.69) years); 117 (43.3%) males; 216 (80%) Blacks; 139 (51.5%) in 65 and older age group were included. Vitamin D levels were less than 20 ng/mL in 95 (35.2%) patients. During admission, 72 patients (26.7%) died, 59 (21.9%) needed mechanical ventilation, and 87 (32.2%) required ICU. Vitamin D levels showed no significant association with mortality (OR = 0.69; 95% CI, 0.39-1.24; P = 0.21), need for mechanical ventilation (OR = 1.23; 95% CI, 0.68-2.24; P = 0.49), new DVT or PE(OR= 0.92; 95% CI, 0.16-5.11; P = 1.00) or ICU admission (OR = 1.38; 95% CI, 0.81-2.34; P = 0.23). We did not find any significant association of vitamin D levels with mortality, the need for mechanical ventilation, ICU admission and the development of thromboembolism in COVID-19 patients. NEW & NOTEWORTHY Low vitamin D has been associated with increased frequency and severity of respiratory tract infections in the past. Current literature linking clinical outcomes in COVID-19 with low vitamin D is debatable. This study evaluated the role of vitamin D in severe disease outcomes among COVID-19 patients and found no association of vitamin D levels with mortality, the need for mechanical ventilation, ICU admission, and thromboembolism in COVID-19.
AUTHOR CONTRIBUTIONS P.L., P.N., and N.P. conceived and designed research; P.L. and S.K. analyzed data; P.L. and S.K. interpreted results of experiments; P.L., P.N., N.P., and S.K. prepared figures; P.L., P.N., and S.K. drafted manuscript; P.L., P.N., N.P., and S.K. edited and revised manuscript; P.L., P.N., N.P., and S.K. approved final version of manuscript.
References
Adams, Ren, Liu, Chun, Lagishetty et al., Vitamin D-directed rheostatic regulation of monocyte antibacterial responses, J Immunol,
doi:10.4049/jimmunol.0803736
Anderson, Geleris, Anderson, Zucker, Nobel et al., Body mass index and risk for intubation or death in SARS-CoV-2 infection: a retrospective cohort study, Ann Intern Med,
doi:10.7326/M20-3214
Blondon, Rodabough, Budrys, Johnson, Berger et al., The effect of calcium plus vitamin D supplementation on the risk of venous thromboembolism: from the Women's Health Initiative Randomized Controlled Trial, Thromb Haemost,
doi:10.1160/TH14-05-0478
Braun, Chang, Mahadevappa, Gibbons, Liu et al., Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill, Crit Care Med,
doi:10.1097/CCM.0b013e318206ccdf
Brodin, Lerstad, Grimnes, Braekkan, Vik et al., Serum levels of vitamin D are not associated with future risk of venous thromboembolism: the Tromsø study, Thromb Haemost,
doi:10.1160/TH12-10-0728
Brøndum-Jacobsen, Benn, Tybjaerg-Hansen, Nordestgaard, 25-Hydroxyvitamin D concentrations and risk of venous thromboembolism in the general population with 18,791 participants, J Thromb Haemost,
doi:10.1111/jth.12118
Cantorna, Snyder, Lin, Yang, Vitamin D and 1,25(OH)2D regulation of T cells, Nutrients,
doi:10.3390/nu7043011
Carpagnano, Lecce, Quaranta, Zito, Buonamico et al., Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19, J Endocrinol Invest,
doi:10.1007/s40618-020-01370-x
Charan, Goyal, Saxena, Yadav, Vitamin D for prevention of respiratory tract infections: a systematic review and meta-analysis, J Pharmacol Pharmacother,
doi:10.4103/0976-500X.103685
Charoenngam, Holick, Immunologic effects of vitamin D on human health and disease, Nutrients,
doi:10.3390/nu12072097
D'avolio, Avataneo, Manca, Cusato, Nicol O et al., 25-Hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2, Nutrients,
doi:10.3390/nu12051359
Dancer, Parekh, Lax, Souza, Zheng et al., Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS), Thorax,
doi:10.1136/thoraxjnl-2014-206680
De Haan, Groeneveld, De Geus, Egal, Struijs, Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis, Crit Care,
doi:10.1186/s13054-014-0660-4
Ginde, Mansbach, Camargo, Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey, Arch Intern Med,
doi:10.1001/archinternmed.2008.560
Grasselli, Zangrillo, Zanella, Antonelli, Cabrini et al., Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy, JAMA,
doi:10.1001/jama.2020.5394
Greiller, Martineau, Modulation of the immune response to respiratory viruses by vitamin D, Nutrients,
doi:10.3390/nu7064240
Hansdottir, Monick, Hinde, Lovan, Look et al., Respiratory epithelial cells convert inactive vitamin D to its active form: potential effects on host defense, J Immunol,
doi:10.4049/jimmunol.181.10.7090
Hastie, Mackay, Ho, Celis-Morales, Katikireddi et al., Vitamin D concentrations and COVID-19 infection in UK Biobank, Diabetes Metab Syndr,
doi:10.1016/j.dsx.2020.04.050
Hwang, Hu, Hu, Zhu, Liu et al., Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirusinfected pneumonia in Wuhan, China, JAMA,
doi:10.1001/jama.2020.1585
Ilie, Stefanescu, Smith, The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality, Aging Clin Exp Res,
doi:10.1007/s40520-020-01570-8
Janssens, Bouillon, Claes, Carremans, Lehouck et al., Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene, Thorax,
doi:10.1136/thx.2009.120659
Jeffery, Burke, Mura, Zheng, Qureshi et al., 1,25-Dihydroxyvitamin D3 and IL-2 combine to inhibit T cell production of inflammatory cytokines and promote development of regulatory T cells expressing CTLA-4 and FoxP3, J Immunol,
doi:10.4049/jimmunol.0803217
Jolliffe, Griffiths, Martineau, Vitamin D in the prevention of acute respiratory infection: systematic review of clinical studies, J Steroid Biochem Mol Biol,
doi:10.1016/j.jsbmb.2012.11.017
Khunti, Singh, Pareek, Hanif, Is ethnicity linked to incidence or outcomes of covid-19?, BMJ,
doi:10.1136/bmj.m1548
Klok, Kruip, Van Der Meer, Arbous, Gommers et al., Incidence of thrombotic complications in critically ill ICU patients with COVID-19, Thromb Res,
doi:10.1016/j.thromres.2020.04.013
Laird, Rhodes, Kenny, Vitamin D and inflammation: potential implications for severity of Covid-19, Ir Med J
Lei, Zhang, Cheng, Lee, Mechanisms of action of vitamin D as supplemental therapy for pneumocystis pneumonia, Antimicrob Agents Chemother,
doi:10.1128/AAC.01226-17
Lemire, Adams, Kermani-Arab, Bakke, Sakai et al., 1,25-Dihydroxyvitamin D3 suppresses human T helper/inducer lymphocyte activity in vitro, J Immunol
Liu, Stenger, Li, Wenzel, Tan et al., Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response, Science,
doi:10.1126/science.1123933
Lucidarme, Messai, Mazzoni, Arcade, Cheyron, Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study, Intensive Care Med,
doi:10.1007/s00134-010-1875-8
Martineau, Jolliffe, Hooper, Greenberg, Aloia et al., Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data, BMJ,
doi:10.1136/bmj.i6583
Mckinney, Bailey, Garrett, Peiris, Manning et al., Relationship between vitamin D status and ICU outcomes in veterans, J Am Med Dir Assoc,
doi:10.1016/j.jamda.2010.04.004
Mehta, Mcauley, Brown, Sanchez, Tattersall et al., and HLH Across Speciality Collaboration UK. COVID-19: consider cytokine storm syndromes and immunosuppression, Lancet,
doi:10.1016/S0140-6736(20)30628-0
Meltzer, Best, Zhang, Vokes, Arora et al., Association of vitamin D status and other clinical characteristics with COVID-19 test results, JAMA Netw Open,
doi:10.1001/jamanetworkopen.2020.19722
Munshi, Hussein, Toraih, Elshazli, Jardak et al., Vitamin D insufficiency as a potential culprit in critical COVID-19 patients, J Med Virol,
doi:10.1002/jmv.26360
Olliver, Spelmink, Hiew, Meyer-Hoffert, Henriques-Normark et al., Immunomodulatory effects of vitamin D on innate and adaptive immune responses to Streptococcus pneumoniae, J Infect Dis,
doi:10.1093/infdis/jit355
Remmelts, Van De Garde, Meijvis, Peelen, Damoiseaux et al., Addition of vitamin D status to prognostic scores improves the prediction of outcome in community-acquired pneumonia, Clin Infect Dis,
doi:10.1093/cid/cis751
Schwalfenberg, A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency, Mol Nutr Food Res,
doi:10.1002/mnfr.201000174
Scragg, Stewart, Waayer, Lawes, Toop et al., Effect of monthly high-dose vitamin D supplementation on cardiovascular disease in the vitamin D assessment study: a randomized clinical trial, JAMA Cardiol,
doi:10.1001/jamacardio.2017.0175
Shi, Liu, Yao, Xing, Zhao et al., Chronic vitamin D deficiency induces lung fibrosis through activation of the renin-angiotensin system, Sci Rep,
doi:10.1038/s41598-017-03474-6
Stokes, Zambrano, Anderson, Marder, Raz et al., Coronavirus Disease 2019 Case Surveillance: United States, MMWR Morb Mortal Wkly Rep,
doi:10.15585/mmwr.mm6924e2
Tartof, Qian, Hong, Wei, Nadjafi et al., Obesity and mortality among patients diagnosed with COVID-19: results from an integrated health care organization, Ann Intern Med,
doi:10.7326/M20-3742
Urashima, Segawa, Okazaki, Kurihara, Wada et al., Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren, Am J Clin Nutr,
doi:10.3945/ajcn.2009.29094
Venkatram, Chilimuri, Adrish, Salako, Patel et al., Vitamin D deficiency is associated with mortality in the medical intensive care unit, Crit Care,
doi:10.1186/cc10585
Vu Cković, Van Rein, Cannegieter, Rosendaal, Lijfering, Vitamin supplementation on the risk of venous thrombosis: results from the MEGA case-control study, Am J Clin Nutr,
doi:10.3945/ajcn.114.095398
Wei, Christakos, Mechanisms underlying the regulation of innate and adaptive immunity by vitamin D, Nutrients,
doi:10.3390/nu7105392
Wu, He, Low vitamin D levels are associated with the development of deep venous thromboembolic events in patients with ischemic stroke, Clin Appl Thromb Hemost,
doi:10.1177/1076029618786574
Xu, Yang, Chen, Luo, Zhang et al., Vitamin D alleviates lipopolysaccharide-induced acute lung injury via regulation of the renin-angiotensin system, Mol Med Rep,
doi:10.3892/mmr.2017.7546
Yang, Zheng, Gou, Pu, Chen et al., 2: a systematic review and meta-analysis
Zdrenghea, Makrinioti, Bagacean, Bush, Johnston et al., Vitamin D modulation of innate immune responses to respiratory viral infections, Rev Med Virol,
doi:10.1002/rmv.1909
Zhang, Leung, Richers, Liu, Remigio et al., Vitamin D inhibits monocyte/macrophage proinflammatory cytokine production by targeting MAPK phosphatase-1, J Immunol,
doi:10.4049/jimmunol.1102412
Zhang, Wan, Sun, Kan, Wang, Association between vitamin D deficiency and mortality in critically ill adult patients: a meta-analysis of cohort studies, Crit Care,
doi:10.1186/s13054-014-0684-9
Zhang, Wu, Li, Zhao, Gq, Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality, Int J Antimicrob Agents,
doi:10.1016/j.ijantimicag.2020.105954
Zhou, Du, Huang, Wang, Shi et al., Preventive effects of vitamin D on seasonal influenza A in infants: a multicenter, randomized, open, controlled clinical trial, Pediatr Infect Dis J,
doi:10.1097/INF.0000000000001890
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