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Association of vitamin D level and severity of COVID-19 disease

Singhsakul et al., Journal of Southeast Asian Medical Research, doi:10.55374/jseamed.v8.202
Jun 2024  
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Severe case 51% Improvement Relative Risk Moderate case 67% Vitamin D for COVID-19  Singhsakul et al.  Sufficiency Are vitamin D levels associated with COVID-19 outcomes? Retrospective 97 patients in Thailand (September - November 2021) Lower severe cases with higher vitamin D levels (p=0.016) c19early.org Singhsakul et al., J. Southeast Asian .., Jun 2024 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.
5,000+ studies for 109 treatments. c19early.org
Retrospective 97 hospitalized COVID-19 patients in Thailand showing vitamin D deficiency associated with higher risk of severe illness.
This is the 199th of 207 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 165,787,330 vigintillion).
risk of severe case, 51.2% lower, RR 0.49, p = 0.02, high D levels (≥20ng/mL) 16 of 52 (30.8%), low D levels (<20ng/mL) 28 of 45 (62.2%), NNT 3.2, adjusted per study, inverted to make RR<1 favor high D levels (≥20ng/mL), odds ratio converted to relative risk, multivariable.
moderate case, 67.3% lower, RR 0.33, p = 0.34, high D levels (≥20ng/mL) 2 of 52 (3.8%), low D levels (<20ng/mL) 2 of 45 (4.4%), adjusted per study, inverted to make RR<1 favor high D levels (≥20ng/mL), odds ratio converted to relative risk, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Singhsakul et al., 9 Jun 2024, retrospective, Thailand, peer-reviewed, mean age 50.8, 6 authors, study period 1 September, 2021 - 30 November, 2021. Contact: sasiwimon.tra@gmail.com.
This PaperVitamin DAll
ASSOCIATION OF VITAMIN D LEVEL AND SEVERITY OF COVID-19 DISEASE
Amol Singhsakul, Bancha Satirapoj, Sirinthip Nimitphuwadon, Sirate Rapeepattana, Saovanee Benjamanukul, Sasiwimon Traiyan
Journal of Southeast Asian Medical Research, doi:10.55374/jseamed.v8.202
Background: Studies indicate that vitamin D can lower the incidence of viral respiratory infections and is necessary for the human immune system to function properly. Vitamin D deficiency may be a risk factor for the severity of COVID-19, including mortality, hospitalization, and length of hospital stay. Objectives: This study aimed to investigate the association between vitamin D levels and the severity of COVID-19 disease. Methods: The participants were COVID-19 patients aged 18 years or older who tested positive for the virus on Real-Time PCR tests, treated as inpatients at Banphaeo General Hospital between September 1 and November 30, 2021. For each patient, baseline characteristics, including sex, weight, height, and underlying diseases, were collected. Three categories were used to categorize COVID-19 disease: mild, moderate, and severe. At the beginning of the study, blood tests were performed on each patient to determine their 25-hydroxyvitamin D levels. Results: Of 97 patients, 64 were male (66%), with a mean age of 50.8±17.7 years. The mean vitamin D level was 27.8±9.6 ng/mL, with 45 (46.4%) showing vitamin D deficiency and 39 (40.2%) indicating vitamin D insufficiency. Among COVID-19 patients with vitamin D deficiency, 28 (63.6%) were classified as severe, compared to only 16 severe cases (36.4%) among those without vitamin D deficiency, demonstrating statistically significant differences (p=0.006). Patients with vitamin D deficiency had a 3.97 times higher risk of experiencing severity (95% CI: 1.67, 9.41, p=0.002) than those without a vitamin D deficit. After adjusting for variable factors, results indicated that patients with vitamin D deficiency had a 3.78-fold increased risk of getting severe illness than those without deficiency (95% CI: 1.28, 11.19, p=0.016). Conclusion: These findings suggested that vitamin D deficiency was associated with the severity of COVID-19.
Conflict of interest The authors declare they have no conflict of interest.
References
Adami, Rossini, Bogliolo, Cantatore, Varenna et al., An exploratory study on the role of vitamin D supplementation in improving pain and disease activity in rheumatoid arthritis, Mod Rheumatol
Annweiler, Hanotte, De L'eprevier, Sabatier, Lafaie et al., Vitamin D and survival in COVID-19 patients: A quasi-experimental study, J Steroid Biochem Mol Biol
Aranow, Journal of investigative medicine : the official publication of the, American Federation for Clinical Research
Campi, Gennari, Merlotti, Mingiano, Frosali et al., Vitamin D and COVID-19 severity and related mortality: a prospective study in Italy, BMC Infect Dis
Chailurkit, Aekplakorn, Ongphiphadhanakul, Regional variation and determinants of vitamin D status in sunshine-abundant Thailand, BMC Public Health
D'avolio, Avataneo, Manca, Cusato, Nicolò et al., 25-hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2, Nutrients
Dimitrov, White, Species-specific regulation of innate immunity by vitamin D signaling, J Steroid Biochem Mol Biol
Hanff, Harhay, Brown, Cohen, Mohareb, Is there an association between COVID-19 mortality and the renin-angiotensin system? A call for epidemiologic investigations, Clin Infect Dis
Hansdottir, Monick, Hinde, Lovan, Look et al., Respiratory epithelial cells convert inactive vitamin D to its active form: Potential effects on host defense, J Immunol
Holick, Binkley, Bischoff-Ferrari, Gordon, Hanley et al., Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline, J Clin Endocrinol Metab
Hossein-Nezhad, Holick, Vitamin D for health: A global perspective, Mayo Clin Proc
Jiang, Chou, Chen, Cathelicidin attenuates hyperoxia-induced lung injury by inhibiting oxidative stress in newborn rats, Free Radic Biol Med
Karatekin, Kaya, Salihoğlu, Balci, Nuhoğlu, Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers, Eur J Clin Nutr
Martineau, Jolliffe, Greenberg, Aloia, Bergman et al., Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis, Health Technol Assess
Mercola, Grant, Wagner, Evidence regarding vitamin D and risk of COVID-19 and its severity, Nutrients
Murai, Fernandes, Sales, Pinto, Goessler et al., 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
Nimitphong, Holick, Vitamin D status and sun exposure in southeast Asia, Dermatoendocrinol
Palacios, Gonzalez, Is vitamin D deficiency a major global public health problem?, J Steroid Biochem Mol Biol
Rhodes, Subramanian, Laird, Griffin, Kenny, Perspective: Vitamin D deficiency and COVID-19 severity -plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis, J Intern Med
Sassi, Tamone, Amelio, Vitamin D: Nutrient, hormone, and immunomodulator, Nutrients
Shah, Varna, Sharma, Mavalankar, Does vitamin D supplementation reduce COVID-19 severity?: a systematic review, QJM
Siwamogsatham, Ongphiphadhanakul, Tangpricha, Vitamin D deficiency in Thailand, J Clin Transl Endocrinol
Teshome, Adane, Girma, Mekonnen, The impact of vitamin D level on COVID-19 infection: Systematic review and meta-analysis, Front Public Health
Wang, Joshi, Jackson, Christensen, Nayfeh, Association of vitamin D deficiency with COVID-19 infection severity: Systematic review and metaanalysis, Clin Endocrinol (Oxf)
Wiersinga, Rhodes, Cheng, Peacock, Prescott, Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19): A review, JAMA
Wolff, Nee, Hickey, Marschollek, Risk factors for Covid-19 severity and fatality: a structured literature review, Infection
Ye, Tang, Liao, Shaw, Deng et al., Does serum vitamin D level affect COVID-19 infection and its severity? -A case-control study, J Am Coll Nutr
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' 'Vitamin D deficiency may be a risk factor for the severity of COVID-19, including mortality, ' 'hospitalization, and length of hospital stay.\n' 'Objectives: This study aimed to investigate the association between vitamin D levels and the ' 'severity of COVID-19 disease.\n' 'Methods: The participants were COVID-19 patients aged 18 years or older who tested positive ' 'for the virus on Real-Time PCR tests, treated as inpatients at Banphaeo General Hospital ' 'between September 1 and November 30, 2021. For each patient, baseline characteristics, ' 'including sex, weight, height, and underlying diseases, were collected. Three categories were ' 'used to categorize COVID-19 disease: mild, moderate, and severe. At the beginning of the ' 'study, blood tests were performed on each patient to determine their 25-hydroxyvitamin D ' 'levels.\n' 'Results: Of 97 patients, 64 were male (66%), with a mean age of 50.8±17.7 years. The mean ' 'vitamin D level was 27.8±9.6 ng/mL, with 45 (46.4%) showing vitamin D deficiency and 39 ' '(40.2%) indicating vitamin D insufficiency. Among COVID-19 patients with vitamin D ' 'deficiency, 28 (63.6%) were classified as severe, compared to only 16 severe cases (36.4%) ' 'among those without vitamin D deficiency, demonstrating statistically significant differences ' '(p=0.006). Patients with vitamin D deficiency had a 3.97 times higher risk of experiencing ' 'severity (95% CI: 1.67, 9.41, p=0.002) than those without a vitamin D deficit. After ' 'adjusting for variable factors, results indicated that patients with vitamin D deficiency had ' 'a 3.78-fold increased risk of getting severe illness than those without deficiency (95% CI: ' '1.28, 11.19, p=0.016). 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Clin Endocrinol (Oxf) 2022; 96: ' '281-7.', 'DOI': '10.1111/cen.14540'}, { 'key': '4579', 'doi-asserted-by': 'crossref', 'unstructured': 'Karatekin G, Kaya A, Salihoğlu Ö, Balci H, Nuhoğlu A. Association of ' 'subclinical vitamin D deficiency in newborns with acute lower ' 'respiratory infection and their mothers. Eur J Clin Nutr 2009; 63: ' '473–7.', 'DOI': '10.1038/sj.ejcn.1602960'}, { 'key': '4580', 'doi-asserted-by': 'crossref', 'unstructured': 'Dimitrov V, White JH. Species-specific regulation of innate immunity by ' 'vitamin D signaling. J Steroid Biochem Mol Biol 2016; 164: 246–53.', 'DOI': '10.1016/j.jsbmb.2015.09.016'}, { 'key': '4581', 'doi-asserted-by': 'crossref', 'unstructured': 'Sassi F, Tamone C, D’Amelio P. Vitamin D: Nutrient, hormone, and ' 'immunomodulator. Nutrients 2018; 10: 1656.', 'DOI': '10.3390/nu10111656'}, { 'key': '4582', 'doi-asserted-by': 'crossref', 'unstructured': 'Martineau AR, Jolliffe DA, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz ' 'G, et al. Vitamin D supplementation to prevent acute respiratory ' 'infections: individual participant data meta-analysis. Health Technol ' 'Assess 2019; 23: 1–44.', 'DOI': '10.3310/hta23020'}, { 'key': '4583', 'unstructured': 'SACN. Update of rapid review: Vitamin D and acute respiratory tract ' 'infections. Accessed November11 2022. ' 'https://assetspublishingservicegovuk/government/uploads/system/uploads/attachment_data/file/945179/SACN_December2020_VitaminD_AcuteRespiratoryTractInfectionspdf.'}, { 'key': '4584', 'doi-asserted-by': 'crossref', 'unstructured': 'Mercola J, Grant WB, Wagner CL. Evidence regarding vitamin D and risk of ' 'COVID-19 and its severity. Nutrients 2020; 12: 3361.', 'DOI': '10.3390/nu12113361'}, { 'key': '4585', 'doi-asserted-by': 'crossref', 'unstructured': 'Teshome A, Adane A, Girma B, Mekonnen ZA. The impact of vitamin D level ' 'on COVID-19 infection: Systematic review and meta-analysis. 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