Vitamin D deficiency and COVID-19: A case-control study at a tertiary care hospital in India
Nirav Nimavat, Shruti Singh, Pratibha Singh, Sunil Kumar Singh, Nishi Sinha
Annals of Medicine and Surgery, doi:10.1016/j.amsu.2021.102661
Background: As the pandemic COVID-19 affected developing and developed countries, there is no proven treatment options available yet. The anti-inflammatory, antiviral and immune modulator effect of Vitamin D could be beneficial to COVID-19. Aim: To find out the possible association between Vitamin D and COVID-19. Methods: The present case-control study was conducted at tertiary care hospital, AIIMS, Patna, Bihar, India. Total 156 cases and 204 controls were enrolled in the study after obtaining informed consent. Categorization of the patients were done based on clinical severity and level of Vitamin D. The association between these categories with different variables were analyzed using regression analysis and other statistical tests. Results: The status of Vitamin D (optimal, mild to moderate deficiency and severe deficiency) differed significantly among cases and controls. Diabetes and hypertension were most prevalent comorbidities among cases. On regression analysis, the difference in Vitamin D level was significant (aOR, 3.295; 95%CI,). The association between Vitamin D status and clinical severity group was statistically significant among cases. Among all variables, age, diabetes, hypertension and clinical severity were associated with worst outcome.
Conclusion: Vitamin D status appears to be strongly associated with COVID-19 clinical severity. After COVID-19 confirmation, Vitamin D level should be measured in all patients and curative plus preventive therapy should be initiated.
Author contribution All authors contributed significantly and in agreement with the content of the article. All authors were involved in project design, data collection, analysis, statistical analysis, data interpretation and writing the manuscript. All authors read and approved the final, submitted version.
Registration of research studies 1 Research Registry registration ID -researchregistry7001 Guarantor Shruti Singh.
Conflict of interest The authors declare that they have no conflict of interests.
Funding agency There was not any direct fund to carry out the research.
References
Agha, Abdall-Razak, Crossley, STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery, Int. J. Surg,
doi:10.1016/j.ijsu.2019.11.002Arentz, Yim, Klaff, Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington state, J. Am. Med. Assoc,
doi:10.1001/jama.2020.4326Bhatraju, Ghassemieh, Nichols, Covid-19 in critically ill patients in the seattle region -case series, N. Engl. J. Med,
doi:10.1056/NEJMoa2004500Bouillon, Marcocci, Carmeliet, Skeletal and extraskeletal actions of vitamin D: current evidence and outstanding questions, Endocr. Rev,
doi:10.1210/er.2018-00126Cannell, Vieth, Willett, Cod liver oil, vitamin A toxicity, frequent respiratory infections, and the vitamin D deficiency epidemic, Ann. Otol. Rhinol. Laryngol,
doi:10.1177/000348940811701112Carpagnano, Di Lecce, Quaranta, 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-xClark, Mcdonagh, Mcmanus, Martin, COVID-19 and hypertension: risks and management. A scientific statement on behalf of the British and Irish Hypertension Society, J. Hum. Hypertens,
doi:10.1038/s41371-020-00451-xDankers, Colin, Van Hamburg, Lubberts, Vitamin D in autoimmunity: molecular mechanisms and therapeutic potential, Front. Immunol,
doi:10.3389/fimmu.2016.00697Ginde, 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.2008.560Greiller, Martineau, Modulation of the immune response to respiratory viruses by vitamin D, Nutrients,
doi:10.3390/nu7064240Hoffmann, Kleine-Weber, Schroeder, SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor, Cell,
doi:10.1016/j.cell.2020.02.052Ilie, Stefanescu, Smith, The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality, Aging Clin. Exp. Res,
doi:10.1007/s40520-020-01570-8Infante, Ricordi, Sanchez, Influence of vitamin D on islet autoimmunity and beta-cell function in type 1 diabetes, Nutrients,
doi:10.3390/nu11092185Jakovac, COVID-19 and vitamin D-Is there a link and an opportunity for intervention?, Am. J. Physiol. Endocrinol. Metab,
doi:10.1152/ajpendo.00138.2020Khan, Chen, Geiger, Role of endolysosomes in severe acute respiratory syndrome coronavirus-2 infection and coronavirus disease 2019 pathogenesis: implications for potential treatments, Front. Pharmacol,
doi:10.3389/fphar.2020.595888Li, Zhang, Zhuo, The vasoprotective axes of the renin-angiotensin system: physiological relevance and therapeutic implications in cardiovascular, hypertensive and kidney diseases, Pharmacol. Res,
doi:10.1016/j.phrs.2017.06.005Lim, Bae, Kwon, Nauck, COVID-19 and diabetes mellitus: from pathophysiology to clinical management, Nat. Rev. Endocrinol,
doi:10.1038/s41574-020-00435-4Mahdavi, A brief review of interplay between vitamin D and angiotensinconverting enzyme 2: implications for a potential treatment for COVID-19, Rev. Med. Virol,
doi:10.1002/rmv.2119Mamani, Muceli, Ghasemi Basir, Vasheghani, Association between serum concentration of 25-hydroxyvitamin D and communityacquired pneumonia: a case-control study, Int. J. Gen. Med,
doi:10.2147/IJGM.S149049Martineau, Jolliffe, Greenberg, Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis, Health Technol. Assess,
doi:10.3310/hta23020Martineau, Jolliffe, Hooper, Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data, BMJ,
doi:10.1136/bmj.i6583Mendy, Apewokin, Wells, Morrow, Factors associated with hospitalization and disease severity in a racially and ethnically diverse population of COVID-19 patients, MedRxiv Prepr. Serv. Heal. Sci,
doi:10.1101/2020.06.25.20137323Munshi, Hussein, Toraih, Vitamin D insufficiency as a potential culprit in critical COVID-19 patients, J. Med. Virol,
doi:10.1002/jmv.26360Panagiotou, Tee, Ihsan, Low serum 25-hydroxyvitamin D (25[OH] D) levels in patients hospitalized with COVID-19 are associated with greater disease severity, Clin. Endocrinol,
doi:10.1111/cen.14276Pinzon, Pradana, Vitamin D deficiency among patients with COVID-19: case series and recent literature review, Trop. Med. Health,
doi:10.1186/s41182-020-00277-wPiroth, Cottenet, Mariet, Comparison of the characteristics, morbidity, and mortality of COVID-19 and seasonal influenza: a nationwide, population-based retrospective cohort study, Lancet Respir. Med,
doi:10.1016/S2213-2600(20)30527-0Ricci, Pagliuca, D'ascanio, Circulating Vitamin D levels status and clinical prognostic indices in COVID-19 patients, Respir. Res,
doi:10.1186/s12931-021-01666-3Singh, Nimavat, Kumar, Singh, Ahmad et al., Prevalence of low level of vitamin D among COVID-19 patients and associated risk factors in India -a hospital-based study, Int. J. Gen. Med,
doi:10.2147/IJGM.S309003Talebi, Rasooli Nejad, Yaseri, Hadadi, Association of vitamin D status with the severity and mortality of community-acquired pneumonia in Iran during 2016-2017: a prospective cohort study, Reports Biochem. Mol. Biol
Tramontana, Napoli, El-Hajj Fuleihan, Strollo, The D-side of COVID-19: musculoskeletal benefits of vitamin D and beyond, Endocrine,
doi:10.1007/s12020-020-02407-0Tsujino, Ushikoshi-Nakayama, Yamazaki, Matsumoto, Saito, Pulmonary activation of vitamin D3 and preventive effect against interstitial pneumonia, J. Clin. Biochem. Nutr,
doi:10.3164/jcbn.19-48Urashima, Segawa, Okazaki, Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren, Am. J. Clin. Nutr,
doi:10.3945/ajcn.2009.29094Vo, Koppel, Espinola, Vitamin D status at the time of hospitalization for bronchiolitis and its association with disease severity, J. Pediatr,
doi:10.1016/j.jpeds.2018.07.097Wan, Shang, Graham, Baric, Li, Receptor recognition by the novel coronavirus from wuhan: an analysis based on decade-long structural studies of SARS coronavirus, J. Virol,
doi:10.1128/JVI.00127-20Yang, Yu, Xu, Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Lancet Respir. Med,
doi:10.1016/S2213-2600(20)30079-5Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3DOI record:
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