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Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients

Orchard et al., Clin Chem Lab Med, doi:10.1515/cclm-2020-1567
Jan 2021  
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ICU admission 59% Improvement Relative Risk Mortality 24% Ventilation 9% Vitamin D for COVID-19  Orchard et al.  Sufficiency Are vitamin D levels associated with COVID-19 outcomes? Retrospective 115 patients in the United Kingdom Lower ICU admission with higher vitamin D levels (p=0.0014) c19early.org Orchard et al., Clin Chem Lab Med, Jan 2021 Favorsvitamin D Favorscontrol 0 0.5 1 1.5 2+
Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
 
*, now with p < 0.00000000001 from 122 studies, recognized in 9 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments. c19early.org
Retrospective 165 hospitalized patients with known vitamin D levels, showing an associated between vitamin D deficiency and ICU admission. There was no statistically significant difference in clinical outcomes for ICU patients. It's unclear why authors do not provide clinical outcomes for all patients rather than ICU only.
This is the 42nd of 199 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 835,162 vigintillion).
risk of ICU admission, 58.8% lower, RR 0.41, p = 0.001, high D levels 9 of 40 (22.5%), low D levels 41 of 75 (54.7%), NNT 3.1, all hospitalized patients, >50 nmol/L.
risk of death, 24.1% lower, RR 0.76, p = 1.00, high D levels 1 of 9 (11.1%), low D levels 6 of 41 (14.6%), NNT 28, ICU patients only, >50 nmol/L.
risk of mechanical ventilation, 8.9% lower, RR 0.91, p = 0.70, high D levels 6 of 9 (66.7%), low D levels 30 of 41 (73.2%), NNT 15, ICU patients only, >50 nmol/L.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Orchard et al., 19 Jan 2021, retrospective, United Kingdom, peer-reviewed, 7 authors.
This PaperVitamin DAll
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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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>', 'DOI': '10.1515/cclm-2020-1567', 'type': 'journal-article', 'created': {'date-parts': [[2021, 1, 23]], 'date-time': '2021-01-23T06:33:46Z', 'timestamp': 1611383626000}, 'page': '1155-1163', 'source': 'Crossref', 'is-referenced-by-count': 30, 'title': 'Vitamin-D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 ' 'patients', 'prefix': '10.1515', 'volume': '59', 'author': [ { 'given': 'Laurence', 'family': 'Orchard', 'sequence': 'first', 'affiliation': [ { 'name': 'General Intensive Care Unit , University Hospital Southampton ' 'NHS Foundation Trust , Southampton , UK'}]}, { 'given': 'Matthew', 'family': 'Baldry', 'sequence': 'additional', 'affiliation': [ { 'name': 'General Intensive Care Unit , University Hospital Southampton ' 'NHS Foundation Trust , Southampton , UK'}]}, { 'given': 'Myra', 'family': 'Nasim-Mohi', 'sequence': 'additional', 'affiliation': [ { 'name': 'General Intensive Care Unit , University Hospital Southampton ' 'NHS Foundation Trust , Southampton , UK'}]}, { 'given': 'Chantelle', 'family': 'Monck', 'sequence': 'additional', 'affiliation': [ { 'name': 'Southampton Specialist Virology Centre , University of ' 'Southampton School of Medicine, University Hospital Southampton ' 'NHS Foundation Trust , Southampton , UK'}]}, { 'given': 'Kordo', 'family': 'Saeed', 'sequence': 'additional', 'affiliation': [ { 'name': 'Microbiology Innovation and Research Unit, Department of ' 'Microbiology , University Hospital Southampton NHS Foundation ' 'Trust , Southampton , UK'}, { 'name': 'Faculty of Medicine , University of Southampton University, ' 'Hospital Southampton , Southampton , UK'}]}, { 'given': 'Michael P. 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' 'https://doi.org/10.1136/postgradmedj-2020-138712 [Epub ahead of print].', 'DOI': '10.1136/postgradmedj-2020-138712'}], 'container-title': 'Clinical Chemistry and Laboratory Medicine (CCLM)', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.degruyter.com/view/journals/cclm/ahead-of-print/article-10.1515-cclm-2020-1567/article-10.1515-cclm-2020-1567.xml', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.degruyter.com/document/doi/10.1515/cclm-2020-1567/xml', 'content-type': 'application/xml', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://www.degruyter.com/document/doi/10.1515/cclm-2020-1567/pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 8, 22]], 'date-time': '2021-08-22T02:04:42Z', 'timestamp': 1629597882000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.degruyter.com/document/doi/10.1515/cclm-2020-1567/html'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 1, 19]]}, 'references-count': 35, 'journal-issue': { 'issue': '6', 'published-online': {'date-parts': [[2021, 1, 15]]}, 'published-print': {'date-parts': [[2021, 5, 26]]}}, 'alternative-id': ['10.1515/cclm-2020-1567'], 'URL': 'http://dx.doi.org/10.1515/cclm-2020-1567', 'relation': {}, 'ISSN': ['1434-6621', '1437-4331'], 'subject': ['Biochemistry (medical)', 'Clinical Biochemistry', 'General Medicine'], 'published': {'date-parts': [[2021, 1, 19]]}}
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