Vitamin A Plasma Levels in COVID-19 Patients: A Prospective Multicenter Study and Hypothesis
Phil-Robin Tepasse, Richard Vollenberg, Manfred Fobker, Iyad Kabar, Hartmut Schmidt, Jörn Arne Meier, Tobias Nowacki, Anna Hüsing-Kabar
Nutrients, doi:10.3390/nu13072173
COVID-19 is a pandemic disease that causes severe pulmonary damage and hyperinflammation. Vitamin A is a crucial factor in the development of immune functions and is known to be reduced in cases of acute inflammation. This prospective, multicenter observational cross-sectional study analyzed vitamin A plasma levels in SARS-CoV-2 infected individuals, and 40 hospitalized patients were included. Of these, 22 developed critical disease (Acute Respiratory Distress Syndrome [ARDS]/Extracorporeal membrane oxygenation [ECMO]), 9 developed severe disease (oxygen supplementation), and 9 developed moderate disease (no oxygen supplementation). A total of 47 age-matched convalescent persons that had been earlier infected with SARS-CoV-2 were included as the control group. Vitamin A plasma levels were determined by high-performance liquid chromatography. Reduced vitamin A plasma levels correlated significantly with increased levels of inflammatory markers (CRP, ferritin) and with markers of acute SARS-CoV-2 infection (reduced lymphocyte count, LDH). Vitamin A levels were significantly lower in hospitalized patients than in convalescent persons (p < 0.01). Of the hospitalized patients, those who were critically ill showed significantly lower vitamin A levels than those who were moderately ill (p < 0.05). Vitamin A plasma levels below 0.2 mg/L were significantly associated with the development of ARDS ]; p = 0.048) and mortality ], p = 0.042). Taken together, we conclude that vitamin A plasma levels in COVID-19 patients are reduced during acute inflammation and that severely reduced plasma levels of vitamin A are significantly associated with ARDS and mortality.
Supplementary Materials: The following are available online at https://www.mdpi.com/article/10 .3390/nu13072173/s1, Supplementary Figure S1 Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Data cannot be made public as personal patient data are included.
Conflicts of Interest: The authors declare no conflict of interest.
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'abstract': '<jats:p>COVID-19 is a pandemic disease that causes severe pulmonary damage and '
'hyperinflammation. Vitamin A is a crucial factor in the development of immune functions and '
'is known to be reduced in cases of acute inflammation. This prospective, multicenter '
'observational cross-sectional study analyzed vitamin A plasma levels in SARS-CoV-2 infected '
'individuals, and 40 hospitalized patients were included. Of these, 22 developed critical '
'disease (Acute Respiratory Distress Syndrome [ARDS]/Extracorporeal membrane oxygenation '
'[ECMO]), 9 developed severe disease (oxygen supplementation), and 9 developed moderate '
'disease (no oxygen supplementation). A total of 47 age-matched convalescent persons that had '
'been earlier infected with SARS-CoV-2 were included as the control group. Vitamin A plasma '
'levels were determined by high-performance liquid chromatography. Reduced vitamin A plasma '
'levels correlated significantly with increased levels of inflammatory markers (CRP, ferritin) '
'and with markers of acute SARS-CoV-2 infection (reduced lymphocyte count, LDH). Vitamin A '
'levels were significantly lower in hospitalized patients than in convalescent persons (p < '
'0.01). Of the hospitalized patients, those who were critically ill showed significantly lower '
'vitamin A levels than those who were moderately ill (p < 0.05). Vitamin A plasma levels '
'below 0.2 mg/L were significantly associated with the development of ARDS (OR = 5.54 '
'[1.01–30.26]; p = 0.048) and mortality (OR 5.21 [1.06–25.5], p = 0.042). Taken together, we '
'conclude that vitamin A plasma levels in COVID-19 patients are reduced during acute '
'inflammation and that severely reduced plasma levels of vitamin A are significantly '
'associated with ARDS and mortality.</jats:p>',
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