Vitamin A Plasma Levels in COVID-19 Patients: A Prospective Multicenter Study and Hypothesis
Tepasse et al.,
Vitamin A Plasma Levels in COVID-19 Patients: A Prospective Multicenter Study and Hypothesis,
Nutrients, doi:10.3390/nu13072173
Prospective analysis of 40 hospitalized patients and 47 age-matched convalescent patients, showing significantly lower vitamin A levels in critical patients, and significantly lower vitamin A levels in hospitalized patients vs. controls. Low vitamin A levels were significantly associated with ARDS and mortality in hospitalized patients.
risk of death, 69.7% lower, RR 0.30, p = 0.04, treatment 4 of 29 (13.8%), control 5 of 11 (45.5%), NNT 3.2, inverted to make RR<1 favor treatment, odds ratio converted to relative risk, >2mg/L, logistic regression.
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risk of progression, 45.2% lower, RR 0.55, p = 0.048, treatment 13 of 29 (44.8%), control 9 of 11 (81.8%), NNT 2.7, inverted to make RR<1 favor treatment, odds ratio converted to relative risk, progression to ARDS, >2mg/L, logistic regression.
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Tepasse et al., 24 Jun 2021, prospective, Germany, peer-reviewed, 8 authors.
Abstract: nutrients
Article
Vitamin A Plasma Levels in COVID-19 Patients: A Prospective
Multicenter Study and Hypothesis
Phil-Robin Tepasse 1, *,† , Richard Vollenberg 1,† , Manfred Fobker 2 , Iyad Kabar 1 , Hartmut Schmidt 1 ,
Jörn Arne Meier 1 , Tobias Nowacki 1 and Anna Hüsing-Kabar 1
1
2
*
†
Citation: Tepasse, P.-R.; Vollenberg,
R.; Fobker, M.; Kabar, I.; Schmidt, H.;
Meier, J.A.; Nowacki, T.;
Hüsing-Kabar, A. Vitamin A Plasma
Levels in COVID-19 Patients: A
Prospective Multicenter Study and
Hypothesis. Nutrients 2021, 13, 2173.
https://doi.org/10.3390/nu13072173
Academic Editors: Dimitrios
T. Karayiannis and Zafeiria Mastora
Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology,
University Hospital Muenster, 48149 Muenster, Germany; richard.vollenberg@ukmuenster.de (R.V.);
iyad.kabar@ukmuenster.de (I.K.); hepar@ukmuenster.de (H.S.); joernarne.meier@ukmuenster.de (J.A.M.);
tobias.nowacki@ukmuenster.de (T.N.); Anna.Huesing-Kabar@ukmuenster.de (A.H.-K.)
Center for Laboratory Medicine, University Hospital Muenster, 48149 Muenster, Germany;
manfred.fobker@ukmuenster.de
Correspondence: phil-robin.tepasse@ukmuenster.de; Tel.: +49-251-834-4882
These authors contributed equally to this work.
Abstract: 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.
Received: 27 May 2021
Accepted: 20 June 2021
Published: 24 June 2021
Keywords: COVID-19; vitamin A; retinol; retinoic acid; ARDS; pneumonia; pandemic; SARS-CoV2; inflammation
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