Vitamin D deficiency in critically ill COVID-19 ARDS patients
Retrospective 26 ICU patients showing that the majority of patients had vitamin D deficiency. There was no statistically significant association of 25-hydroxyvitamin D status and clinical course, however low levels of 1,25-dihydroxyvitamin D were associated with prolonged mechanical ventilation and a worse APACHE II score. Clinical outcomes based on baseline vitamin D status are not provided.
Notz et al., 7 Mar 2021, peer-reviewed, 12 authors.
Abstract: Clinical Nutrition xxx (xxxx) xxx
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Clinical Nutrition
journal homepage: http://www.elsevier.com/locate/clnu
Covid-19
Vitamin D deficiency in critically ill COVID-19 ARDS patients
Quirin Notz a, *, Johannes Herrmann a, Tobias Schlesinger a, Peter Kranke a,
Magdalena Sitter a, Philipp Helmer a, Jan Stumpner a, Daniel Roeder a, Karin Amrein b,
Christian Stoppe a, Christopher Lotz a, Patrick Meybohm a
a
b
Department of Anesthesiology and Intensive Care Medicine, University Hospital Wuerzburg, Germany
Division of Endocrinology and Diabetology, Medical University of Graz, Austria
a r t i c l e i n f o
s u m m a r y
Article history:
Received 15 December 2020
Accepted 1 March 2021
Background & aims: Vitamin D's pleiotropic effects include immune modulation, and its supplementation has been shown to prevent respiratory tract infections. The effectivity of vitamin D as a therapeutic
intervention in critical illness remains less defined. The current study analyzed clinical and immunologic
effects of vitamin D levels in patients suffering from coronavirus disease 2019 (COVID-19) induced acute
respiratory distress syndrome (ARDS).
Methods: This was a single-center retrospective study in patients receiving intensive care with a
confirmed SARS-CoV-2 infection and COVID-19 ARDS. 25-hydroxyvitamin D and 1,25-dihydroxyvitamin
D serum levels, pro- and anti-inflammatory cytokines and immune cell subsets were measured on
admission as well as after 10e15 days. Clinical parameters were extracted from the patient data management system. Standard operating procedures included the daily administration of vitamin D3 via
enteral feeding.
Results: A total of 39 patients with COVID-19 ARDS were eligible, of which 26 were included in this study
as data on vitamin D status was available. 96% suffered from severe COVID-19 ARDS. All patients without
prior vitamin D supplementation (n ¼ 22) had deficient serum levels of 25-hydroxyvitamin D. Vitamin D
supplementation resulted in higher serum levels of 25-hydroxyvitamin D but not did not increase 1,25dihydroxyvitamin D levels after 10e15 days. Clinical parameters did not differ between patients with
sufficient or deficient levels of 25-hydroxyvitamin D. Only circulating plasmablasts were higher in patients with 25-hydroxyvitamin D levels 30 ng/ml (p ¼ 0.029). Patients with 1,25-dihydroxyvitamin D
levels below 20 pg/ml required longer mechanical ventilation (p ¼ 0.045) and had a worse acute
physiology and chronic health evaluation (APACHE) II score (p ¼ 0.048).
Conclusion: The vast majority of COVID-19 ARDS patients had vitamin D deficiency. 25-hydroxyvitamin D
status was not related to changes in clinical course, whereas low levels of 1,25-dihydroxyvitamin D were
associated with prolonged mechanical ventilation and a worse APACHE II score.
© 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Keywords:
Acute respiratory distress syndrome
Vitamin D
Critical care
Nutrient supplementation
Immune response
Late treatment
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