Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients
Laurence Orchard, Matthew Baldry, Myra Nasim-Mohi, Chantelle Monck, Kordo Saeed, Michael P W Grocott, Dushianthan Ahilanandan
Clinical Chemistry and Laboratory Medicine (CCLM), doi:10.1515/cclm-2020-1567
Objectives: The pattern of global COVID-19 has caused many to propose a possible link between susceptibility, severity and vitamin-D levels. Vitamin-D has known immune modulatory effects and deficiency has been linked to increased severity of viral infections. Methods: We evaluated patients admitted with confirmed SARS-COV-2 to our hospital between March-June 2020. Demographics and outcomes were assessed for those admitted to the intensive care unit (ICU) with normal (>50 nmol/L) and low (<50 nmol/L) vitamin-D. Results: There were 646 SARS-COV-2 PCR positive hospitalisations and 165 (25.5%) had plasma vitamin-D levels. Fifty patients were admitted to ICU. There was no difference in vitamin-D levels of those hospitalised (34, IQR 18.5-66 nmol/L) and those admitted to the ICU (31.5, IQR 21-42 nmol/L). Higher proportion of vitamin-D deficiency (<50 nmol/L) noted in the ICU group (82.0 vs. 65.2%). Among the ICU patients, low vitamin D level (<50 nmol/L) was associated with younger age (57 vs. 67 years, p=0.04) and lower cycle threshold (CT) real time polymerase chain reaction values (RT-PCR) (26.96 vs. 33.6, p=0.02) analogous to higher viral loads. However, there were no significant differences in ICU clinical outcomes (invasive and non-invasive mechanical ventilation, acute kidney injury and mechanical ventilation and hospital days) between patients with low and normal vitamin-D levels. Conclusions: Despite the association of low vitamin-D levels with low CT values, there is no difference in clinical outcomes in this small cohort of critically ill COVID-19 patients. The complex relationship between vitamin-D levels and COVID-19 infection needs further exploration with large scale randomized controlled trials.
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'abstract': '<jats:title>Abstract</jats:title>\n'
' <jats:sec id="j_cclm-2020-1567_abs_001">\n'
' <jats:title>Objectives</jats:title>\n'
' <jats:p>The pattern of global COVID-19 has caused many to propose a '
'possible link between susceptibility, severity and vitamin-D levels. Vitamin-D has known '
'immune modulatory effects and deficiency has been linked to increased severity of viral '
'infections.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec id="j_cclm-2020-1567_abs_002">\n'
' <jats:title>Methods</jats:title>\n'
' <jats:p>We evaluated patients admitted with confirmed SARS-COV-2 to our '
'hospital between March-June 2020. Demographics and outcomes were assessed for those admitted '
'to the intensive care unit (ICU) with normal (>50\xa0nmol/L) and low (<50\xa0nmol/L) '
'vitamin-D.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec id="j_cclm-2020-1567_abs_003">\n'
' <jats:title>Results</jats:title>\n'
' <jats:p>There were 646 SARS-COV-2 PCR positive hospitalisations and 165 '
'(25.5%) had plasma vitamin-D levels. Fifty patients were admitted to ICU. There was no '
'difference in vitamin-D levels of those hospitalised (34, IQR 18.5–66\xa0nmol/L) and those '
'admitted to the ICU (31.5, IQR 21–42\xa0nmol/L). Higher proportion of vitamin-D deficiency '
'(<50\xa0nmol/L) noted in the ICU group (82.0 vs. 65.2%). Among the ICU patients, low '
'vitamin D level (<50\xa0nmol/L) was associated with younger age (57 vs. 67 years, p=0.04) '
'and lower cycle threshold (CT) real time polymerase chain reaction values (RT-PCR) (26.96 vs. '
'33.6, p=0.02) analogous to higher viral loads. However, there were no significant differences '
'in ICU clinical outcomes (invasive and non-invasive mechanical ventilation, acute kidney '
'injury and mechanical ventilation and hospital days) between patients with low and normal '
'vitamin-D levels.</jats:p>\n'
' </jats:sec>\n'
' <jats:sec id="j_cclm-2020-1567_abs_004">\n'
' <jats:title>Conclusions</jats:title>\n'
' <jats:p>Despite the association of low vitamin-D levels with low CT values, '
'there is no difference in clinical outcomes in this small cohort of critically ill COVID-19 '
'patients. The complex relationship between vitamin-D levels and COVID-19 infection needs '
'further exploration with large scale randomized controlled trials.</jats:p>\n'
' </jats:sec>',
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