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Cholecalciferol level and its impact on COVID-19 patients

Saeed et al., The Egyptian Journal of Internal Medicine, doi:10.1186/s43162-022-00116-w
Feb 2022  
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Vitamin D for COVID-19
8th treatment shown to reduce risk in October 2020
 
*, now known with p < 0.00000000001 from 120 studies, recognized in 8 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,100+ studies for 60+ treatments. c19early.org
Prospective study of 414 COVID+ ICU patients in Egypt, showing mortality associated with lower vitamin D levels.
Saeed et al., 21 Feb 2022, prospective, Egypt, peer-reviewed, 3 authors.
This PaperVitamin DAll
Cholecalciferol level and its impact on COVID-19 patients
Mohammed Abdel Monem Saeed, Alaa Hussein Mohamed, Ahmed Hassan Owaynat
The Egyptian Journal of Internal Medicine, doi:10.1186/s43162-022-00116-w
Background: Cholecalciferol is an important nutrient and essential to build body, maintain strong bones, and improves immunity. The main source for vitamin D is the body's skin which absorbs the sun's ultraviolet rays and convert them into vitamin D; at the same time, deficiency can occur or people may not get enough supplementation; this occurs mainly in old age, not taking healthy food, or have darker skin, and this deficient cases can raise the risk of severe COVID-19 if infected. Vitamin D boosts immunity and decreases inflammation. Poorer outcome of corona virus-disease (COVID-19) has been suggested to be due to vitamin D deficiency. We suggested to find the effect of cholecalciferol levels 25-hydroxy vitamin D (25 OHD) on the severity and mortality in patients suffering from COVID-19. Methods: Our study is a prospective following of 414 patients admitted in Helwan University Hospitals in the period of June 2020 till October 2021 for severely symptomatic. COVID-19 patients with median of age 54.55 ± 14.27, with a definite range of APACHE II score ranging from 15 to 19 where we measured vitamin D 3 level (cholecalciferol level), correlating the assay level to the inflammatory cytokine storm markers on admission, on the fifth day and after 10 days also the level of vitamin D 3 was correlated to the length of stay mechanical ventilation days and mortality. Results: Lower level of vitamin D 3 on admission was strongly evident in patients with severely symptomatic and in mortality of COVID-19 patients 58.25 ± 24.59 nmol/L when compared with patients who survived 103.97 ± 36.14 nmol/L with P value < 0.001. Also, when correlating the initial level of vitamin D 3 on admission with the level of the inflammatory cytokine storm markers on admission, on fifth day from admission and on the tenth day, it shows a strong inverse correlation between vitamin D 3 level on admission and ferritin level on fifth day ρ-0.739 p value < 0.001 also on the tenth day ρ-0.885, P value < 0.001, in comparing also with D-dimer on fifth day ρ-0.858, p value < 0.001 also showing a strong inverse correlation with a highly significant p value this also evident on the D-dimer level on the tenth day ρ-0.889 with p value < 0.001, CRP at fifth and tenth day ρ-0.868, P value < 0.001, ρ-0.891, P value < 0.001 respectively also in correlating the LDH level on the fifth and tenth day with the initial level of vitamin D 3 it shows a strong inverse correlation with a highly significant p value. ρ-0.887, P value < 0.001, ρ-0.878, p value < 0.001 respectively, in the fifth and tenth day. Neutrophil to lymphocyte ratio was strongly, inversely correlated to the vitamin D 3 level (cholecalciferol) on admission with ρ-0.753, p < 0.001, ρ-0.882, P < 0.001 respectively. Also, chest computed tomography in the fifth and
Authors' contributions MS, AM, and AO read and approved the final manuscript. Funding No funding. Declarations Ethics approval and consent to participate All taken and available. Consent for publication Available. Competing interests All authors declare that they have no competing interests. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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{ 'DOI': '10.1186/s43162-022-00116-w', 'ISSN': ['1110-7782', '2090-9098'], 'URL': 'http://dx.doi.org/10.1186/s43162-022-00116-w', 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>Cholecalciferol is an important nutrient and essential to build body, ' 'maintain strong bones, and improves immunity.</jats:p>\n' ' <jats:p>The main source for vitamin D is the body’s skin which absorbs the ' 'sun’s ultraviolet rays and convert them into vitamin D; at the same time, deficiency can ' 'occur or people may not get enough supplementation; this occurs mainly in old age, not taking ' 'healthy food, or have darker skin, and this deficient cases can raise the risk of severe ' 'COVID-19 if infected.</jats:p>\n' ' <jats:p>Vitamin D boosts immunity and decreases inflammation. Poorer outcome ' 'of corona virus—disease (COVID-19) has been suggested to be due to vitamin D ' 'deficiency.</jats:p>\n' ' <jats:p>We suggested to find the effect of cholecalciferol levels 25-hydroxy ' 'vitamin D (25 OHD) on the severity and mortality in patients suffering from ' 'COVID-19.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>Our study is a prospective following of 414 patients admitted in ' 'Helwan University Hospitals in the period of June 2020 till October 2021 for severely ' 'symptomatic. COVID-19 patients with median of age 54.55\u2009±\u200914.27, with a definite ' 'range of APACHE II score ranging from 15 to 19 where we measured vitamin ' 'D<jats:sub>3</jats:sub> level (cholecalciferol level), correlating the assay level to the ' 'inflammatory cytokine storm markers on admission, on the fifth day and after 10 days also the ' 'level of vitamin D<jats:sub>3</jats:sub> was correlated to the length of stay mechanical ' 'ventilation days and mortality.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>Lower level of vitamin D<jats:sub>3</jats:sub> on admission was ' 'strongly evident in patients with severely symptomatic and in mortality of COVID-19 patients ' '58.25\u2009±\u200924.59 nmol/L when compared with patients who survived 103.97 ± 36.14 nmol/L ' 'with <jats:italic>P</jats:italic> value &lt; 0.001.</jats:p>\n' ' <jats:p>Also, when correlating the initial level of vitamin ' 'D<jats:sub>3</jats:sub> on admission with the level of the inflammatory cytokine storm ' 'markers on admission, on fifth day from admission and on the tenth day, it shows a strong ' 'inverse correlation between vitamin D<jats:sub>3</jats:sub> level on admission and ferritin ' 'level on fifth day ρ–0.739 <jats:italic>p</jats:italic> value &lt; 0.001 also on the tenth ' 'day ρ–0.885, <jats:italic>P</jats:italic> value &lt; 0.001, in comparing also with D-dimer on ' 'fifth day ρ–0.858, <jats:italic>p</jats:italic> value &lt; 0.001 also showing a strong ' 'inverse correlation with a highly significant <jats:italic>p</jats:italic> value this also ' 'evident on the D-dimer level on the tenth day ρ–0.889 with <jats:italic>p</jats:italic> value ' '&lt; 0.001, CRP at fifth and tenth day ρ–0.868, <jats:italic>P</jats:italic> value &lt; ' '0.001, ρ–0.891, <jats:italic>P</jats:italic> value &lt; 0.001 respectively also in ' 'correlating the LDH level on the fifth and tenth day with the initial level of vitamin ' 'D<jats:sub>3</jats:sub> it shows a strong inverse correlation with a highly significant ' '<jats:italic>p</jats:italic> value. ρ–0.887, <jats:italic>P</jats:italic> value &lt; 0.001, ' 'ρ–0.878, <jats:italic>p</jats:italic> value &lt; 0.001 respectively, in the fifth and tenth ' 'day. Neutrophil to lymphocyte ratio was strongly, inversely correlated to the vitamin ' 'D<jats:sub>3</jats:sub> level (cholecalciferol) on admission with ρ–0.753, ' '<jats:italic>p</jats:italic> &lt; 0.001, ρ–0.882, <jats:italic>P</jats:italic> &lt; 0.001 ' 'respectively. Also, chest computed tomography in the fifth and tenth day of admission showed ' 'a very strong inverse correlation with vitamin D level and a highly significant statistical ' 'difference ρ–0.655, <jats:italic>p</jats:italic> value &lt; 0.001 respectively.</jats:p>\n' ' <jats:p>Length of stay and mechanical ventilation days were also strongly ' 'inversely correlated to the cholecalciferol level ρ–0.795, <jats:italic>p</jats:italic> &lt; ' '0.001, ρ– 0.879, <jats:italic>P</jats:italic> &lt; 0.001 ROC curve of vitamin ' 'D<jats:sub>3</jats:sub> to predict mortality (RR 0.865, 95% CI 0.828–0.896, ' '<jats:italic>P</jats:italic> &lt; 0.001, with cut off-value for vit. D<jats:sub>3</jats:sub> ' '&lt; 60 nmol/L, regardless of other factors like age, gender, and presence of other ' 'co-morbidities.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>Low level of cholecalciferol was strongly inversely correlated with ' 'cytokine storm markers and independent predictor of severity and mortality in COVID-19 ' 'patients.</jats:p>\n' ' </jats:sec>', 'alternative-id': ['116'], 'article-number': '23', 'assertion': [ { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'Received', 'name': 'received', 'order': 1, 'value': '23 November 2021'}, { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'Accepted', 'name': 'accepted', 'order': 2, 'value': '28 January 2022'}, { 'group': {'label': 'Article History', 'name': 'ArticleHistory'}, 'label': 'First Online', 'name': 'first_online', 'order': 3, 'value': '21 February 2022'}, {'group': {'label': 'Declarations', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 1}, { 'group': {'label': 'Ethics approval and consent to participate', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 2, 'value': 'All taken and available.'}, { 'group': {'label': 'Consent for publication', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 3, 'value': 'Available.'}, { 'group': {'label': 'Competing interests', 'name': 'EthicsHeading'}, 'name': 'Ethics', 'order': 4, 'value': 'All authors declare that they have no competing interests.'}], 'author': [ {'affiliation': [], 'family': 'Saeed', 'given': 'Mohammed Abdel Monem', 'sequence': 'first'}, {'affiliation': [], 'family': 'Mohamed', 'given': 'Alaa Hussein', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Owaynat', 'given': 'Ahmed Hassan', 'sequence': 'additional'}], 'container-title': ['The Egyptian Journal of Internal Medicine'], 'content-domain': {'crossmark-restriction': False, 'domain': ['link.springer.com']}, 'created': {'date-parts': [[2022, 2, 21]], 'date-time': '2022-02-21T18:11:49Z', 'timestamp': 1645467109000}, 'deposited': { 'date-parts': [[2022, 2, 21]], 'date-time': '2022-02-21T18:14:17Z', 'timestamp': 1645467257000}, 'indexed': {'date-parts': [[2022, 2, 21]], 'date-time': '2022-02-21T18:42:05Z', 'timestamp': 1645468925016}, 'is-referenced-by-count': 0, 'issn-type': [{'type': 'print', 'value': '1110-7782'}, {'type': 'electronic', 'value': '2090-9098'}], 'issue': '1', 'issued': {'date-parts': [[2022, 2, 21]]}, 'journal-issue': {'issue': '1', 'published-print': {'date-parts': [[2022, 12]]}}, 'language': 'en', 'license': [ { 'URL': 'https://creativecommons.org/licenses/by/4.0', 'content-version': 'tdm', 'delay-in-days': 0, 'start': { 'date-parts': [[2022, 2, 21]], 'date-time': '2022-02-21T00:00:00Z', 'timestamp': 1645401600000}}, { 'URL': 'https://creativecommons.org/licenses/by/4.0', 'content-version': 'vor', 'delay-in-days': 0, 'start': { 'date-parts': [[2022, 2, 21]], 'date-time': '2022-02-21T00:00:00Z', 'timestamp': 1645401600000}}], 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s43162-022-00116-w.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s43162-022-00116-w/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s43162-022-00116-w.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'member': '297', 'original-title': [], 'prefix': '10.1186', 'published': {'date-parts': [[2022, 2, 21]]}, 'published-online': {'date-parts': [[2022, 2, 21]]}, 'published-print': {'date-parts': [[2022, 12]]}, 'publisher': 'Springer Science and Business Media LLC', 'reference': [ { 'DOI': '10.1001/jama.2020.5775', 'author': 'DJ Cook', 'doi-asserted-by': 'publisher', 'first-page': '1559', 'issue': '16', 'journal-title': 'JAMA', 'key': '116_CR1', 'unstructured': 'Cook DJ, Marshall JC, Fowler RA (2020) Critical illness in patients with ' 'COVID-19: mounting an effective clinical and research response. 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Eur JNutr 60:545–548. ' 'https://doi.org/10.1007/s00394-020-02372-4', 'volume': '60', 'year': '2020'}, { 'DOI': '10.1210/clinem/dgz282', 'author': 'R Bouillon', 'doi-asserted-by': 'publisher', 'first-page': 'dgz282', 'journal-title': 'J Clin Endocrinol Metab', 'key': '116_CR50', 'unstructured': 'Bouillon R (2020) Safety of high-dose vitamin D supplementation. J Clin ' 'Endocrinol Metab 105:dgz282. https://doi.org/10.1210/clinem/dgz282', 'volume': '105', 'year': '2020'}, { 'DOI': '10.1111/febs.15534', 'author': 'CA Camargo Jr', 'doi-asserted-by': 'publisher', 'first-page': '3689', 'issue': '17', 'journal-title': 'FEBS J', 'key': '116_CR51', 'unstructured': 'Camargo CA Jr, Martineau AR (2020) Vitamin D to prevent COVID-19: ' 'recommendations for the design of clinical trials. FEBS J ' '287(17):3689–3692. https://doi.org/10.1111/febs.15534', 'volume': '287', 'year': '2020'}, { 'DOI': '10.1016/j.jsbmb.2020.105751', 'author': 'M Entrenas Castillo', 'doi-asserted-by': 'publisher', 'first-page': '105751', 'journal-title': 'J Steroid Biochem Mol Biol', 'key': '116_CR52', 'unstructured': 'Entrenas Castillo M, Entrenas Costa LM, Vaquero Barrios JM, Alcala Diaz ' 'JF, Lopez Miranda J, Bouillon R, Quesada Gomez JM (2020) Effect of ' 'calcifediol treatment and best available therapy versus best available ' 'therapy on intensive care unit admission and mortality among patients ' 'hospitalized for COVID-19: a pilot randomized clinical study. J Steroid ' 'Biochem Mol Biol 203:105751. https://doi.org/10.1016/j.jsbmb.2020.105751', 'volume': '203', 'year': '2020'}, { 'DOI': '10.18632/aging.202307', 'author': 'B Cangiano', 'doi-asserted-by': 'publisher', 'first-page': '24522', 'issue': '24', 'journal-title': 'Aging (Albany NY)', 'key': '116_CR53', 'unstructured': 'Cangiano B, Fatti LM, Danesi L, Gazzano G, Croci M, Vitale G et al ' '(2020) Mortality in an Italian nursing home during COVID-19 pandemic: ' 'correlation with gender, age, ADL, vitamin D supplementation, and ' 'limitations of the diagnostic tests. Aging (Albany NY) ' '12(24):24522–24534. https://doi.org/10.18632/aging.202307', 'volume': '12', 'year': '2020'}, { 'DOI': '10.3390/nul2113377', 'author': 'G Annweiler', 'doi-asserted-by': 'publisher', 'first-page': '3377', 'issue': '11', 'journal-title': 'Nutrients', 'key': '116_CR54', 'unstructured': 'Annweiler G, Corvaisier M, Gautier J, Dubee V, Legrand E, Sacco G, ' 'Annweiler C (2020) Vitamin D supplementation associated to better ' 'survival in hospitalized frail elderly COVID-19 patients: the ' 'GERIA-COVID quasi-experimental study. Nutrients 12(11):3377. ' 'https://doi.org/10.3390/nul2113377', 'volume': '12', 'year': '2020'}, { 'DOI': '10.1136/postgradmedj-2020-139065', 'doi-asserted-by': 'publisher', 'key': '116_CR55', 'unstructured': 'Rastogi A, Bhansali A, Khare N, Suri V, Yaddanapudi N, Sachdeva N et al ' '(2020) Short term, high-dose vitamin D supplementation for COVID-19 ' 'disease: a randomised, placebo-controlled, study (SHADE study). Postgrad ' 'Med J.\xa02020:139065. ' 'https://doi.org/10.1136/postgradmedj-2020-139065.'}, { 'DOI': '10.1001/jama.2020.26848', 'author': 'IH Murai', 'doi-asserted-by': 'publisher', 'first-page': '1053', 'issue': '11', 'journal-title': 'JAMA', 'key': '116_CR56', 'unstructured': 'Murai IH, Fernandes AL, Sales LP, Pinto AJ, Goessler KF, Duran CSC, ' 'Silva CBR, Franco AS, Macedo MB, Dalmolin HHH, Baggio J, Balbi GGM, Reis ' 'BZ, Antonangelo L, Caparbo VF, Gualano B, Pereira RMR (2021) Effect of a ' 'single high dose of vitamin D3 on hospital length of stay in patients ' 'with moderate to severe COVID-19: a randomized clinical trial. JAMA ' '325(11):1053–1060. https://doi.org/10.1001/jama.2020.26848', 'volume': '325', 'year': '2021'}], 'reference-count': 56, 'references-count': 56, 'relation': {}, 'score': 1, 'short-container-title': ['Egypt J Intern Med'], 'short-title': [], 'source': 'Crossref', 'subtitle': [], 'title': ['Cholecalciferol level and its impact on COVID-19 patients'], 'type': 'journal-article', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'volume': '34'}
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment 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.
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