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Low levels of vitamin D were associated with coagulopathy among hospitalized coronavirus disease-19 (COVID-19) patients: A single-centered study in Indonesia

Susianti et al., Journal of Medical Biochemistry, doi:10.5937/jomb0-30228
Feb 2021  
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0 0.5 1 1.5 2+ Mortality 91% Improvement Relative Risk ICU admission 90% Progression 81% Progression (b) 44% Vitamin D for COVID-19  Susianti et al.  Sufficiency Are vitamin D levels associated with COVID-19 outcomes? Retrospective 50 patients in Indonesia Lower mortality (p=0.32) and ICU admission (p=0.32), not sig. c19early.org Susianti et al., J. Medical Biochemistry, Feb 2021 Favors vitamin D Favors control
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 9 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,200+ studies for 70+ treatments. c19early.org
Retrospective 50 hospitalized PCR+ patients in Indonesia showing ICU admission, mortality, ISTH DIC (Disseminated Intravascular Coagulation) score>=5, and increased D-dimer significantly associated with lower vitamin D levels.
This is the 46th of 198 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 361,397 vigintillion).
risk of death, 91.5% lower, RR 0.09, p = 0.32, high D levels 0 of 8 (0.0%), low D levels 9 of 42 (21.4%), NNT 4.7, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), >49.92 nmol/L.
risk of ICU admission, 90.5% lower, RR 0.10, p = 0.32, high D levels 0 of 8 (0.0%), low D levels 8 of 42 (19.0%), NNT 5.2, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm), >49.92 nmol/L.
risk of progression, 81.5% lower, OR 0.19, p = 0.04, high D levels 8, low D levels 42, inverted to make OR<1 favor high D levels, ISTH DIC>=5, >49.92 nmol/L, bivariate, RR approximated with OR.
risk of progression, 44.4% lower, OR 0.56, p = 0.03, high D levels 8, low D levels 42, inverted to make OR<1 favor high D levels, increased D-dimer >2 mg/L, >49.92 nmol/L, multivariate, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Susianti et al., 12 Feb 2021, retrospective, Indonesia, peer-reviewed, 8 authors.
This PaperVitamin DAll
Low levels of vitamin D were associated with coagulopathy among hospitalized coronavirus disease-19 (COVID-19) patients: A single-centered study in Indonesia
Hani Susianti, Cesarius Wahono, Perdana Aditya Rahman, Mirza Pratama, Indah Adhita Wulanda, Khoirunisah Dwi Hartanti, Elvira Sari Dewi, Kusworini Handono
Journal of Medical Biochemistry, doi:10.5937/jomb0-30228
Background: This study was aimed to explore the association of vitamin D in the risk of coagulopathy in coronavirus disease-19 . Methods: Clinical and laboratory findings were obtained from 50 confirmed COVID-19 patients hospitalized in Saiful Anwar General Hospital, Malang, Indonesia, from September to November 2020. Thrombotic events during hospitalization were recorded, and the ISTH disseminated intravascular coagulation (DIC) score was used to classify overt DIC. Hypovitaminosis D was defined by serum vitamin D level <49.92 nmol/L. Results: Among 50 patients, 42 (84%) had hypovitaminosis D, and 6 (12%) developed thrombotic events. Vitamin D levels were lower in patients with thrombotic events (p=0.015), D-dimer >2 mg/L (p=0.006), ISTH DIC score 5 (p=0.020), admitted on ICU (p=0.002), and non-survivor groups (p=0.007). Multivariate analysis for the risk in increased D-dimer levels showed low vitamin D as the only significant risk factor with OR 1.8 (1.2-4.4), p=0.034. Low vitamin D also increased the risk for developing overt DIC with OR. 5.4 (1.0-30.2), p=0.039. Vitamin D level had negative correlations with ferritin (R=-0.316, p=0.044) and CRP (R=-0.530, p=0.000). Kratak sadr`aj Uvod: Cilj ove studije je bio da istra`i povezanost vitamina D sa rizikom od koagulopatije kod koronavirusne bolesti 2019 (COVID-19). Metode: Klini~ki i laboratorijski nalazi dobijeni su od 50 potvr|enih pacijenata sa COVID-19 hospitalizovanih u op{toj bolnici Saiful Anvar u Malangu u Indoneziji, od septembra do novembra 2020. Zabele`eni su tromboti~ni doga|aji tokom hospitalizacije, a rezultati ISTH diseminovane intravaskularne koagulacije (DIC) kori{}eni su za klasifikaciju o~igledne DIC. Hipovitaminoza D je definisana nivoom vitamina D u serumu <49,92 nmol/L. Rezultati: Od 50 pacijenata, 42 (84%) je imalo hipovitaminozu D, a 6 (12%) je razvilo tromboti~ke doga|aje. Nivoi vitamina D su bili ni`i kod pacijenata sa tromboti~kim doga|ajima (p=0,015), D-dimerom >2 mg/L (p=0,006), ISTH DIC rezultatima 5 (p=0,020), primljenih na intenzivnu negu (p=0,002), i grupa koje nisu pre`ivele (p=0,007). Multivarijantna analiza rizika za pove}ane nivoe D-dimera pokazala je nizak nivo vitamina D kao jedini zna~ajni faktor rizika sa OR 1,8 (1,2-4,4), p=0,034. Nizak nivo vitamina D je tako|e pove}ao rizik od razvoja o~iglednog DIC-a sa OR 5,4 (1,0-30,2), p=0,039. Nivo
Conflict of interest statement All the authors declare that they have no conflict of interest in this work.
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Thrombotic events ' 'during hospitalization were recorded, and the ISTH disseminated intravascular coagulation ' '(DIC) score was used to classify overt DIC. Hypovitaminosis D was defined by serum vitamin D ' 'level &lt;49.92 nmol/L. Results: Among 50 patients, 42 (84%) had hypovitaminosis D, and 6 ' '(12%) developed thrombotic events. Vitamin D levels were lower in patients with thrombotic ' 'events (p=0.015), D-dimer &gt;2 mg/L (p=0.006), ISTH DIC score 5 (p=0.020), admitted on ICU ' '(p=0.002), and non-survivor groups (p=0.007). Multivariate analysis for the risk in increased ' 'D-dimer levels showed low vitamin D as the only significant risk factor with OR 1.8 ' '(1.2-4.4), p=0.034. Low vitamin D also increased the risk for developing overt DIC with OR. ' '5.4 (1.0-30.2), p=0.039. Vitamin D level had negative correlations with ferritin (R=-0.316, ' 'p=0.044) and CRP (R=-0.530, p=0.000). Conclusions: In conclusion, a low level of vitamin D ' 'was found in most hospitalized COVID-19 patients and might be associated with the development ' 'of coagulopathy.</jats:p>', 'DOI': '10.5937/jomb0-30228', 'type': 'journal-article', 'created': {'date-parts': [[2021, 2, 12]], 'date-time': '2021-02-12T13:57:45Z', 'timestamp': 1613138265000}, 'page': '341-350', 'source': 'Crossref', 'is-referenced-by-count': 7, 'title': 'Low levels of vitamin D were associated with coagulopathy among hospitalized coronavirus ' 'disease-19 (COVID-19) patients: A single-centered study in Indonesia', 'prefix': '10.5937', 'volume': '40', 'author': [ {'given': 'Hani', 'family': 'Susianti', 'sequence': 'first', 'affiliation': []}, { 'suffix': 'Singgih', 'given': 'Cesarius', 'family': 'Wahono', 'sequence': 'additional', 'affiliation': []}, { 'suffix': 'Aditya', 'given': 'Perdana', 'family': 'Rahman', 'sequence': 'additional', 'affiliation': []}, { 'suffix': 'Zaka', 'given': 'Mirza', 'family': 'Pratama', 'sequence': 'additional', 'affiliation': []}, { 'suffix': 'Adhita', 'given': 'Indah', 'family': 'Wulanda', 'sequence': 'additional', 'affiliation': []}, { 'suffix': 'Dwi', 'given': 'Khoirunisah', 'family': 'Hartanti', 'sequence': 'additional', 'affiliation': []}, { 'suffix': 'Sari', 'given': 'Elvira', 'family': 'Dewi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Kusworini', 'family': 'Handono', 'sequence': 'additional', 'affiliation': []}], 'member': '3964', 'reference': [ { 'key': 'ref1', 'unstructured': 'WHO Coronavirus Disease (COVID-19) Dashboard. https: //covid19.who.int/ ' '(accessed 29 November 2020);'}, { 'key': 'ref2', 'doi-asserted-by': 'crossref', 'unstructured': 'Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. 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PLoS One 2017 May 2; 12(5): ' 'e0175517;', 'DOI': '10.1371/journal.pone.0175517'}], 'container-title': 'Journal of Medical Biochemistry', 'original-title': [ 'Niski nivoi vitamina D povezani su sa koagulopatijom kod hospitalizovanih pacijenata ' 'sa koronavirusom (COVID-19) - jednocentrična studija u Indoneziji'], 'language': 'en', 'link': [ { 'URL': 'https://aseestant.ceon.rs/index.php/jomb/article/download/30228/17082', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://scindeks-clanci.ceon.rs/data/pdf/1452-8258/2021/1452-82582104341S.pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2021, 9, 3]], 'date-time': '2021-09-03T21:26:15Z', 'timestamp': 1630704375000}, 'score': 1, 'resource': {'primary': {'URL': 'https://scindeks.ceon.rs/Article.aspx?artid=1452-82582104341S'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021]]}, 'references-count': 31, 'journal-issue': {'issue': '4', 'published-print': {'date-parts': [[2021]]}}, 'URL': 'http://dx.doi.org/10.5937/jomb0-30228', 'relation': {}, 'ISSN': ['1452-8258', '1452-8266'], 'subject': ['Biochemistry (medical)', 'Clinical Biochemistry'], 'container-title-short': 'J Med Biochemistry', 'published': {'date-parts': [[2021]]}}
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