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Evaluation of vitamin A and E deficiency with severity of SARS-COV-2 disease: a case–control study

Mandour et al., The Egyptian Journal of Bronchology, doi:10.1186/s43168-023-00210-9, NCT05946499
Jul 2023  
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ARDS 100% Improvement Relative Risk Vitamin A for COVID-19  Mandour et al.  Sufficiency Are vitamin A levels associated with COVID-19 outcomes? Prospective study of 60 patients in Egypt (September 2021 - April 2022) Lower ARDS with higher vitamin A levels (p=0.001) c19early.org Mandour et al., The Egyptian J. Bronch.., Jul 2023 Favorsvitamin A Favorscontrol 0 0.5 1 1.5 2+
Vitamin A for COVID-19
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Case control study with 30 ICU COVID-19 patients, 30 hospitalized non-ICU patients, and 30 matched healthy controls, showing vitamin A levels associated with COVID-19 and severity, with ICU patient levels < hospitalized patients < healthy controls. Authors also show significantly lower risk of ARDS with vitamin A levels above 0.65µg/ml.
risk of ARDS, 99.7% lower, OR 0.003, p < 0.001, cutoff 0.65μg/ml, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Mandour et al., 21 Jul 2023, prospective, Egypt, peer-reviewed, 5 authors, study period September 2021 - April 2022, trial NCT05946499 (history). Contact: balsam.sherif@kasralainy.edu.eg.
This PaperVitamin AAll
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Vitamins A and E are essential in the enhancement of immunity and they tend to ' 'decrease in cases with inflammation. Determination of serum levels of vitamins A and E in ' 'COVID-19 patients was the aim of the study.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>This case–control study was carried out on 30 ICU–admitted ' 'SARS-CoV-2–infected individuals (group A), 30 ward–admitted SARS-CoV-2–infected individuals ' '(group B) and 30 healthy controls (group C). High-performance liquid chromatography was used ' 'to measure vitamin A and E levels.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Median levels of vitamin A in group A [0.16 (0.08–0.23) µg/ml] were ' 'significantly lower than those in group B [0.4 (0.15–0.65) µg/ml] and in group C [0.81 ' '(0.70–1.16) µg/ml] with <jats:italic>P</jats:italic> value\u2009&lt;\u20090.001, while there ' 'was no significant difference between groups concerning vitamin E levels ' '(<jats:italic>P</jats:italic> value\u2009=\u20090.535). Vitamin A deficiency showed ' 'significant correlation with lower hemoglobin levels, lower platelet counts, higher total ' 'leucocyte counts, higher C- reactive protein levels, and higher D-dimer levels. ROC curve ' 'construction showed that vitamin A level with cut off\u2009&lt;\u20090.65\xa0µg/ml increases ' 'risk of acute respiratory distress syndrome (ARDS)\xa0development with sensitivity 90% and ' 'specificity 83.3%. Logistic regression analysis showed that cases with vitamin A levels\u2009' '&lt;\u20090.65\xa0µg/ml were more prone to develop ARDS (OR\u2009=\u20090.003 [0.000–0.036] ' '<jats:italic>P</jats:italic>\u2009&lt;\u20090.001).</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>Levels of vitamin A were reduced in COVID-19 patients particularly in ' 'ICU–admitted cases. This ensures the association of decreased vitamin A with disease ' 'morbidity and the importance of vitamin A supplementation as part of disease ' 'management.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Trial registration</jats:title>\n' ' <jats:p>Clinicaltrial.gov, NCT05946499. Registered 12 July ' '2023—Retrospectively registered. \n' '<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" ' 'xlink:href="https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000DGLS&amp;selectaction=Edit&amp;uid=U00070DC&amp;ts=2&amp;cx=gieusm">https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000DGLS&amp;selectaction=Edit&amp;uid=U00070DC&amp;ts=2&amp;cx=gieusm</jats:ext-link>.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1186/s43168-023-00210-9', 'type': 'journal-article', 'created': {'date-parts': [[2023, 7, 21]], 'date-time': '2023-07-21T11:02:06Z', 'timestamp': 1689937326000}, 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'Evaluation of vitamin A and E deficiency with severity of SARS-COV-2 disease: a case–control ' 'study', 'prefix': '10.1186', 'volume': '17', 'author': [ {'given': 'Iman Atef', 'family': 'Mandour', 'sequence': 'first', 'affiliation': []}, {'given': 'Sabah Ahmed', 'family': 'Hussein', 'sequence': 'additional', 'affiliation': []}, {'given': 'Hany William Z.', 'family': 'Hanna', 'sequence': 'additional', 'affiliation': []}, {'given': 'Salma Ahmed', 'family': 'Abdellatif', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-5900-5274', 'authenticated-orcid': False, 'given': 'Balsam Sherif', 'family': 'Fahmy', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2023, 7, 21]]}, 'reference': [ { 'issue': '10239', 'key': '210_CR1', 'doi-asserted-by': 'publisher', 'first-page': '1763', 'DOI': '10.1016/S0140-6736(20)31189-2', 'volume': '395', 'author': 'MJ Cummings', 'year': '2020', 'unstructured': 'Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM et ' 'al (2020) Epidemiology, clinical course, and outcomes of critically ill ' 'adults with COVID-19 in New York City: a prospective cohort study. 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' 'https://doi.org/10.1016/j.dsx.2020.04.015', 'journal-title': 'Diabetes Metab Syndr'}, { 'issue': '4', 'key': '210_CR33', 'first-page': '727', 'volume': '38', 'author': 'J Tanaka', 'year': '1979', 'unstructured': 'Tanaka J, Fujiwara H, Torisu M (1979) Vitamin E and immune response I ' 'Enhancement of Helper T-Cell Activity by Dietary Supplementation of ' 'Vitamin E in Mice. Immunology 38(4):727–734.146', 'journal-title': 'Immunology'}, { 'issue': '4', 'key': '210_CR34', 'doi-asserted-by': 'publisher', 'first-page': '487', 'DOI': '10.1002/iub.1976', 'volume': '71', 'author': 'ED Lewis', 'year': '2019', 'unstructured': 'Lewis ED, Meydani SN, Wu D (2019) Regulatory role of vitamin E in the ' 'immune system and inflammation. IUBMB Life 71(4):487–494. ' 'https://doi.org/10.1002/iub.1976', 'journal-title': 'IUBMB Life'}, { 'issue': '14', 'key': '210_CR35', 'doi-asserted-by': 'publisher', 'first-page': '2091', 'DOI': '10.2147/JIR.S307333', 'volume': '21', 'author': 'N Samad', 'year': '2021', 'unstructured': 'Samad N, Dutta S, Sodunke TE, Fairuz A, Sapkota A, Miftah ZF et al ' '(2021) Fat-Soluble Vitamins and the Current Global Pandemic of COVID-19: ' 'Evidence-Based Efficacy from Literature Review. J Inflamm Res ' '21(14):2091–2110. https://doi.org/10.2147/JIR.S307333. ' 'PMID:34045883;PMCID:PMC8149275', 'journal-title': 'J Inflamm Res'}, { 'key': '210_CR36', 'doi-asserted-by': 'publisher', 'first-page': '64', 'DOI': '10.3945/ajcn.111.023812', 'volume': '95', 'author': 'A Duncan', 'year': '2011', 'unstructured': 'Duncan A, Talwar D, McMillan D, Stefanowicz F, O’Reilly DSJ (2011) ' 'Quantitative data on the magnitude of the systemic inflammatory response ' 'and its effect on micronutrient status based on plasma measurements. Am ' 'J Clin Nutr 95:64–71', 'journal-title': 'Am J Clin Nutr'}, { 'issue': '9', 'key': '210_CR37', 'doi-asserted-by': 'publisher', 'first-page': '756217', 'DOI': '10.3389/fped.2021.756217', 'volume': '24', 'author': 'X Wang', 'year': '2021', 'unstructured': 'Wang X, Li X, Jin C, Bai X, Qi X, Wang J et al (2021) Association ' 'Between Serum Vitamin A Levels and Recurrent Respiratory Tract ' 'Infections in Children. Front Pediatr. 24(9):756217. ' 'https://doi.org/10.3389/fped.2021.756217. PMID: 35004539; PMCID: ' 'PMC8740126', 'journal-title': 'Front Pediatr.'}], 'container-title': 'The Egyptian Journal of Bronchology', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s43168-023-00210-9.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s43168-023-00210-9/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s43168-023-00210-9.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 7, 21]], 'date-time': '2023-07-21T11:05:58Z', 'timestamp': 1689937558000}, 'score': 1, 'resource': {'primary': {'URL': 'https://ejb.springeropen.com/articles/10.1186/s43168-023-00210-9'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 7, 21]]}, 'references-count': 37, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2023, 12]]}}, 'alternative-id': ['210'], 'URL': 'http://dx.doi.org/10.1186/s43168-023-00210-9', 'relation': {}, 'ISSN': ['2314-8551'], 'subject': ['General Earth and Planetary Sciences', 'General Environmental Science', 'General Medicine'], 'container-title-short': 'Egypt J Bronchol', 'published': {'date-parts': [[2023, 7, 21]]}, 'assertion': [ { 'value': '25 May 2023', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '14 July 2023', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '21 July 2023', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': "The study has received approval from Cairo University's Faculty of Medicine's " 'research ethics committee (approval number: MS-59–2020; date: 29/4/2020).\xa0' 'Informed consent was obtained from all individual participants included in the ' 'study.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethics approval and consent to participate'}}, { 'value': 'Not applicable.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}, { 'value': 'The authors declare that there is no conflict of interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '36'}
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