Vitamin D Deficiency is Associated with Increased COVID-19 Severity: Prospective Screening of At-Risk Groups is Medically Indicated
MD Samuel H Pepkowitz, MD Calvin J Hobel, James M Mirocha Ms, Kimia.Sobhani, Carissa A Huynh Bs, MD Harneet Jawanda, PhD Wohaib Hasan
doi:10.21203/rs.3.rs-83262/v1
Non-classical actions of Vitamin D are involved in regulation of the immune system including a role in mitigation of excessive in ammation. We hypothesized that vitamin D de ciency existing prior to SARS-CoV-2 infection could contribute to patients developing severe pulmonary compromise as a result of dysfunctional hyperin ammation. 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 signi cantly 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 de ciency 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.
References
Aucoin, Weaver, Thomas, Jones, Vitamin D status of refugees arriving in Canada: ndings from the Calgary Refugee Health Program, Can Fam Physician
Baig, Khaleeq, Ali, Syeda, Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms, ACS Chem Neurosci,
doi:10.1021/acschemneuro.0c00122
Bodnar, Simhan, Powers, Frank, Cooperstein et al., High prevalence of vitamin D insu ciency in black and white pregnant women residing in the northern United States and their neonates, J Nutr,
doi:10.1093/jn/137.2.447
Burton, Fort, Seoane, Hospitalization and Mortality among Black Patients and White Patients with Covid-19, N Engl J Med,
doi:10.1056/NEJMsa2011686
Currie, Findlay, Mcfarlane, Cathelicidins Have Direct Antiviral Activity against Respiratory Syncytial Virus In Vitro and Protective Function In Vivo in Mice and Humans, J Immunol,
doi:10.4049/jimmunol.1502478
Facchiano, Facchiano, Bartoli, Ricci, Facchiano, Reply to Jakovac: About COVID-19 and vitamin D, Am J Physiol Endocrinol Metab,
doi:10.1152/ajpendo.00185.2020
Gentile, Aimo, Forfori, COVID-19 and risk of pulmonary brosis: the importance of planning ahead, Eur J Prev Cardiol,
doi:10.1177/2047487320932695
Gombart, Borregaard, Koe, Hp, Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxyvitamin D3, FASEB J,
doi:10.1096/fj.04-3284com
Hamid, Riggs, Spencer, Redman, Bodenner, Vitamin D de ciency in residents of academic long-term care facilities despite having been prescribed vitamin D, J Am Med Dir Assoc,
doi:10.1016/j.jamda.2006.07.005
Hamid, Riggs, Spencer, Redman, Bodenner, Vitamin D de ciency in residents of academic long-term care facilities despite having been prescribed vitamin D, J Am Med Dir Assoc,
doi:10.1016/j.jamda.2006.07.005
Hooper, Nápoles, Pérez-Stable, COVID-19 and Racial/Ethnic Disparities
Horby, Lim, Dexamethasone in Hospitalized Patients with Covid-19 -Preliminary Report
Kalligeros, Shehadeh, Mylona, Association of Obesity with Disease Severity Among Patients with Coronavirus Disease 2019, Obesity (Silver Spring),
doi:10.1002/oby.22859
Nikolich-Zugich, Knox, Rios, Natt, Bhattacharya et al., Correction to: SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes, Geroscience,
doi:10.1007/s11357-020-00193-1
Parva, Tadepalli, Singh, Prevalence of Vitamin D De ciency and Associated Risk Factors in the US Population (2011-2012), Cureus,
doi:10.7759/cureus.2741
Ritterhouse, Lu, Shah, Vitamin d de ciency in a multiethnic healthy control cohort and altered immune response in vitamin D de cient European-American healthy controls, PLoS One,
doi:10.1371/journal.pone.0094500
Toren-Wielema, Veenhuizen, Kappelle, Veeger, Van Roon, E cacy of a Standardized Oral Vitamin D Dosing Regimen in Nursing Home Residents, Drugs Aging,
doi:10.1007/s40266-018-0601-z
Zhang, Leung, Richers, Vitamin D inhibits monocyte/macrophage proin ammatory cytokine production by targeting MAPK phosphatase-1, J Immunol,
doi:10.4049/jimmunol.1102412
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