The prognostic significance of vitamin D deficiency in patients with COVID-19 pneumonia
et al., Bratislava Medical Journal, doi:10.4149/BLL_2021_119, Sep 2021
Vitamin D for COVID-19
8th treatment shown to reduce risk in
October 2020, now with p < 0.00000000001 from 126 studies, recognized in 18 countries.
No treatment is 100% effective. Protocols
combine treatments.
6,300+ studies for
210+ treatments. c19early.org
|
Retrospective 207 hospitalized patients in Turkey, 37 with vitamin D levels <30ng/ml treated with a single dose of 300,000IU vitamin D, showing lower mortality with treatment.
Cholecalciferol was used in this study.
Meta analysis shows that late stage treatment with calcitriol / calcifediol (or
paricalcitol, alfacalcidol, etc.) is more effective than cholecalciferol: 66% [47‑78%] lower risk vs. 42% [31‑52%] lower risk.
Cholecalciferol requires two hydroxylation steps to become activated - first
in the liver to calcifediol, then in the kidney to calcitriol. Calcitriol,
paricalcitol, and alfacalcidol are active vitamin D analogs that do not
require conversion. This allows them to have more rapid onset of action
compared to cholecalciferol. The time delay for cholecalciferol to increase
serum calcifediol levels can be 2-3 days, and the delay for converting
calcifediol to active calcitriol can be up to 7 days.
Bolus treatment is less effective.
Pharmacokinetics and the potential side effects of high bolus doses suggest
that ongoing treatment spread over time is more appropriate.
Research has confirmed that lower dose regular treatment with vitamin D is more
effective than intermittent high-dose bolus treatment for various conditions,
including rickets and acute respiratory infections1,2. The biological mechanisms supporting these
findings involve the induction of enzymes such as 24-hydroxylase and
fibroblast growth factor 23 (FGF23) by high-dose bolus treatments. These
enzymes play roles in inactivating vitamin D, which can paradoxically reduce
levels of activated vitamin D and suppress its activation for extended periods
post-dosage. Evidence indicates that 24-hydroxylase activity may remain
elevated for several weeks following a bolus dose, leading to reduced levels
of the activated form of vitamin D. Additionally, FGF23 levels can increase
for at least three months after a large bolus dose, which also contributes to
the suppression of vitamin D activation1.
This is the 55th of 126 COVID-19 controlled studies for vitamin D, which collectively show efficacy with p<0.0000000001 (1 in 155 septillion).
30 studies are RCTs, which show efficacy with p=0.0000032.
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risk of death, 80.9% lower, RR 0.19, p = 0.04, treatment 1 of 37 (2.7%), control 24 of 170 (14.1%), NNT 8.8.
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risk of ICU admission, 94.5% lower, RR 0.06, p = 0.13, treatment 0 of 37 (0.0%), control 14 of 170 (8.2%), NNT 12, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
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hospitalization time, 9.6% lower, relative time 0.90, p = 0.32, treatment 37, control 170.
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| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Yildiz et al., 27 Sep 2021, retrospective, Turkey, peer-reviewed, 5 authors, dosage 300,000IU single dose.
The prognostic significance of vitamin D deficiency in patients with COVID-19 pneumonia
Bratislava Medical Journal, doi:10.4149/bll_2021_119
BACKGROUND: Vitamin D has anti-infl ammatory and immunomodulatory effects via the downregulation of pro-infl ammatory cytokines. We aimed to demonstrate the effect of vitamin D levels on survival in COVID-19 patients. MATERIALS AND METHODS: 207 COVID-19 patients were included in the study. Serum vitamin D levels were measured, and patients with levels < 20 ng/ml or 21 to 30 ng received a single 300.000 IU dose of vitamin D. RESULTS: Of 207 patients, 37 received vitamin D, while 170 did not. Demographic, radiologic and mean laboratory values were similar between the groups. The mean plasma vitamin D level without vitamin D support (n=170) was 50.82 ± 16.12 ng/ml (30.28 -81.35) vs. 16.98 ± 6.2 ng/ml (4.20 -28.30) in vitamin D group. The most remarkable fi nding were the mortality rates; while only 1 patient (2.7 %) died in the vitamin D group, 24 patients (14.1 %) died in no vitamin D supplementation group (p = 0.038). CONCLUSION: Although a few retrospective studies put forth a relation between vitamin D defi ciency and COVID-19 course severity there is still paucity of data about the effi cacy of vitamin supplementations in COVID-19 patients. A single 300.000 IU dose of vitamin D seems to represent a useful, practical, and safe adjunctive approach for the treatment or prevention of Fig. 1, Ref. 30).
References
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Late treatment
is less effective
is less effective
