Vitamin D Deficiency is Associated with Increased COVID-19 Severity: Prospective Screening of At-Risk Groups is Medically Indicated
Pepkowitz et al.,
Vitamin D Deficiency is Associated with Increased COVID-19 Severity: Prospective Screening of At-Risk Groups..,
Research Square, doi:10.21203/rs.3.rs-83262/v1 (Preprint)
Retrospective 37 hospitalized patients in the USA, showing higher risk of ICU admission with vitamin D deficiency.
risk of ICU admission, 55.8% lower, RR 0.44, p = 0.01, high D levels (≥20ng/mL) 9 of 24 (37.5%), low D levels (<20ng/mL) 11 of 13 (84.6%), NNT 2.1, inverted to make RR<1 favor high D levels (≥20ng/mL).
|
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
|
Pepkowitz et al., 29 Sep 2020, retrospective, USA, preprint, 7 authors.
Abstract: Vitamin D Deficiency is Associated with Increased
COVID-19 Severity: Prospective Screening of At-Risk
Groups is Medically Indicated
Samuel H Pepkowitz MD ( Samuel.Pepkowitz@cshs.org )
Cedars-Sinai Medical Center https://orcid.org/0000-0002-8384-3227
Calvin J Hobel MD
Cedars-Sinai Medical Center
James M Mirocha MS
Cedars-Sinai Medical Center
Kimia.Sobhani PhD
Cedars-Sinai Medical Center
Carissa A Huynh BS
Cedars-Sinai Medical Center
Harneet Jawanda MD
Cedars-Sinai Medical Center
Wohaib Hasan PhD
Cedars-Sinai Medical Cente
Research Article
Keywords: COVID-19, Vitamin D Deficiency, Pulmonary Inflammation, ICU Care
Posted Date: September 29th, 2020
DOI: https://doi.org/10.21203/rs.3.rs-83262/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
Read Full License
Page 1/10
Abstract
Non-classical actions of Vitamin D are involved in regulation of the immune system including a role in
mitigation of excessive inflammation. We hypothesized that vitamin D deficiency existing prior to SARSCoV-2 infection could contribute to patients developing severe pulmonary compromise as a result of
dysfunctional hyperinflammation. Serum vitamin D concentrations of patients experiencing such severe
COVID-19 manifestations that they required ICU care at any point of their hospitalization were compared
to serum vitamin D concentrations of patients achieving discharge without the need for any ICU care.
Having serum vitamin D < 20 ng/mL was significantly associated with increased COVID-19 severity,
p=0.001. It is conjectured that population groups know to have low serum vitamin D should be
prospectively screened for deficiency and if found emergently treated. Such action could both decrease
the maximum severity suffered by infected individuals and lessen the strain on medical resources by
decreasing the percentage of COVID-19 hospital admissions requiring ICU care.
Background
SARS-CoV-2 infection (COVID-19) manifests itself on a clinical spectrum ranging from asymptomatic
carriage to life-threatening disease with catastrophic compromise often due to a hyperinflammatory
necrotizing pneumonitis [1,2]. African Americans, Native Americans, Hispanic Americans, obese
individuals and the elderly are among groups experiencing disproportionately high levels of severe
disease compared a to younger, normal Body Mass Index (BMI), Caucasian control population [3,4,5,6,7].
However, instead of attributing these discrepancies to genetic susceptibility or unavoidable effects of
aging there is an evolving recognition that asymmetries of socioeconomic status , chronic stress, the
availability of routine and acute medical care, and exposure to toxic environmental factors may be
primarily responsible for the increased morbidity being suffered by these groups [3,8]. These same
groups are also known to be disproportionately 25-hydroxyvitamin D (25VD) insufficient (serum levels of
20-30 ng/dL) or deficient (serum levels<20 ng/dL) [9,10,11]. While the etiology of the necrotizing
pulmonary process is no doubt multifactorial, vitamin D deficiency has been targeted as is a candidate
factor for abetting some of the dysfunctional hyperinflammation [12,13] occurring in these patients.
Vitamin D deficiency affects various macrophage populations generally leading to a dampening of local
production of 1,25-dihydroxyvitamin D (1,25VD), the effector molecule of intracrine, autocrine and
paracrine actions of vitamin D [14]. Specifically, vitamin D..
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
provide medical advice. Before taking any medication, consult a qualified
physician who can provide personalized advice and details of risks and
benefits based on your medical history and situation.
FLCCC and
WCH
provide treatment protocols.
Submit