Is There a Crucial Link Between Vitamin D Status and Inflammatory Response in Patients With COVID-19?
Saponaro et al.
, Is There a Crucial Link Between Vitamin D Status and Inflammatory Response in Patients With COVID-19?
, Frontiers in Immunology, doi:10.3389/fimmu.2021.745713
Retrospective 93 COVID-19 pneumonia patients in Italy, showing low vitamin D levels associated with severe ARDS, and significantly lower vitamin D levels for non-survivors.
risk of ARDS, 36.5% lower, RR 0.64, p = 0.43, high D levels (≥20ng/ml) 5 of 32 (15.6%), low D levels (<20ng/ml) 15 of 61 (24.6%), NNT 11, severe ARDS.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Saponaro et al., 24 Jan 2022, retrospective, Italy, peer-reviewed, 13 authors, study period March 2020 - May 2020.
Abstract: ORIGINAL RESEARCH
published: 24 January 2022
Is There a Crucial Link Between
Vitamin D Status and Inﬂammatory
Response in Patients With
Federica Saponaro 1*, Maria Franzini 2, Chukwuma Okoye 3, Rachele Antognoli 3,
Beatrice Campi 1, Marco Scalese 4, Tommaso Neri 1, Laura Carrozzi 1, Fabio Monzani 3,
Riccardo Zucchi 1, Alessandro Celi 1, Aldo Paolicchi 2 and Alessandro Saba 1† on behalf of
Pisa COVID-19 Study Group†
Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy,
Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy, 3 Department of
Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, 4 Institute of Clinical Physiology, National Council of
Research, Pisa, Italy
Deirdre R. Coombe,
Curtin University, Australia
Ben Gurion University of the Negev,
Peter Ramutis Kvietys,
Alfaisal University, Saudi Arabia
Members are listed in the
This article was submitted to
a section of the journal
Frontiers in Immunology
Received: 13 August 2021
Accepted: 21 December 2021
Published: 24 January 2022
Saponaro F, Franzini M, Okoye C,
Antognoli R, Campi B, Scalese M,
Neri T, Carrozzi L, Monzani F,
Zucchi R, Celi A, Paolicchi A and
Saba A (2022) Is There a Crucial Link
Between Vitamin D Status and
Inﬂammatory Response in
Patients With COVID-19?
Front. Immunol. 12:745713.
Background: Hypovitaminosis D has been suggested to play a possible role in
coronavirus disease 2019 (COVID-19) infection.
Methods: The aim of this study is to analyze the relationship between vitamin D status
and a biochemical panel of inﬂammatory markers in a cohort of patients with COVID-19. A
secondary endpoint was to evaluate the correlation between 25OHD levels and the
severity of the disease. Ninety-three consecutive patients with COVID-19-related
pneumonia were evaluated from March to May 2020 in two hospital units in Pisa, in
whom biochemical inﬂammatory markers, 25OHD levels, P/F ratio at nadir during
hospitalization, and complete clinical data were available.
Results: Sixty-ﬁve percent of patients presented hypovitaminosis D (25OHD ≤ 20 ng/ml)
and showed signiﬁcantly higher IL-6 [20.8 (10.9–45.6) vs. 12.9 (8.7–21.1) pg/ml, p =
0.02], CRP [10.7 (4.2–19.2) vs. 5.9 (1.6–8.1) mg/dl, p = 0.003], TNF-a [8.9 (6.0–14.8) vs.
4.4 (1.5–10.6) pg/ml, p = 0.01], D-dimer [0.53 (0.25–0.72) vs. 0.22 (0.17–0.35) mg/l, p =
0.002], and IL-10 [3.7 (1.8–6.9) vs. 2.3 (0.5–5.8) pg/ml, p = 0.03]. A signiﬁcant inverse
correlation was found between 25OHD and all these markers, even adjusted for age and
sex. Hypovitaminosis D was prevalent in patients with severe ARDS, compared with the
other groups (75% vs. 68% vs. 55%, p < 0.001), and 25OHD levels were lower in nonsurvivor patients.
Conclusions: The relationship between 25OHD levels and inﬂammatory markers
suggests that vitamin D status needs to be taken into account in the management of
these patients. If vitamin D is a marker of poor prognosis or a possible risk factor with
beneﬁcial effects from supplementation, this still needs to be elucidated.
Keywords: COVID-19, SARS-CoV-2, hypovitaminosis D, vitamin D, cytokine storm
Frontiers in Immunology |..
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