Vitamin D Insufficiency in Disease Severity and Prognosis of the Patients with SARS Corona Virus-2 Infection
Role of Vitamin D in COVID-19
-
Ali Asgari
,
Ebrahim Hazrati
,
Saeed Soleiman-Meigooni
,
Mohsen Rajaeinejad
,
Sam Alahyari
,
Malihe Nasiri
Abstract
The global crisis caused by the SARS Corona virus-2 infection is continuing through 2021, with more than 3.5 million deaths. Several risk factors for this virus’s severity and death were documented, including diabetes, hypertension, and ischemic heart disease. To evaluate the relation between serum vitamin D3 level, the disease severity, and prognosis of the patients with SARS Corona virus-2 infection. Patients with COVID-19 were evaluated for serum vitamin D levels and laboratory data. Correlation between vitamin D levels and laboratory data with disease severity and prognosis was assessed. Cox and logistic regression tests, as well as ROC curves, were used for data analysis. Ninety-eight patients with Corona virus-2 disease (COVID-19), which consisted of sixty patients with moderate COVID-19 in the general wards, and thirty-eight patients with severe COVID-19 in the intensive care unit (ICU), were evaluated. The mean age in the general wards was lower than in ICU (60.96±14.86 compared to 67.94±16.46, P=0.001), and the mean serum vitamin D level in the patients admitted in the general wards was higher than in the ICU (31 ng/mL compared to 20.57 ng/mL, P=0.003). Furthermore, vitamin D deficiency (25 (OH) D <25 ng/ml) significantly increased the risk of severe disease. (odds ratio=2.91, P=0.019) and mortality (odds ratio=3.64, P=0.026). Vitamin D deficiency is a risk factor for disease severity and poor prognosis in COVID-19. Vitamin D levels of 25 ng/mL can be used as a cut-off value for predicting severity and prognosis.
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28- Maghbooli Z, Sahraian MA, Ebrahimi M, Pazoki M, Kafan S, Tabriz HM, et al. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PLoS One 2020;15:e0239799
29- Tan CW, Ho LP, Kalimuddin S, Cherng BPZ, Teh YE, Thien SY, et al. A cohort study to evaluate the effect of combination Vitamin D, Magnesium and Vitamin B12 (DMB) on progression to severe outcome in older COVID-19 patients. Nutrition. 2020 Nov-Dec, 111017. doi:10.1101/2020.06.01.20112334.
30- Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 May; 46(5):846-848.
31- Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Jul; 75(7):1730-1741.
32- Ebadi M, Montano-Loza AJ. Perspective: improving vitamin D status in the management of COVID-19. Eur J Clin Nutr. 2020 Jun;74(6):856-859.
2- Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513.
3- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506.
4- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069.
5- Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for gastrointestinal infection of
SARS-CoV-2. Gastroenterology. 2020 May; 158(6):1831-1833.
6- Chen SJ, Wang SC, Chen YC. Novel Antiviral Strategies in the Treatment of COVID-19: A Review. Microorganisms. 2020 Aug 20;8(9):1259. doi: 10.3390/microorganisms8091259.
7- Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5; 383(19):1813-1826.
8- Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017 Jun;18(2):153-165.
9- Zdrenghea MT, Makrinioti H, Bagacean C, Bush A, Johnston SL, Stanciu LA. Vitamin D modulation of innate immune responses to respiratory viral infections. Rev Med Virol 2017 Jan; 27(1).doi: 10.1002/rmv.1909.
10- Gilbert CR, Arum SM, Smith CM. Vitamin D deficiency and chronic lung disease. Can Respir J. 2009 May-Jun; 16(3): 75–80.
11- Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017 Feb 15;356:i6583. doi: 10.1136/bmj.i6583.
12- Griffin MD, Lutz W, Phan VA, Bachman LA,McKean DJ, Kumar R. Dendritic cell modulation by 1,25 dihydroxyvitamin D3 and its analogs: a vitamin D receptor-dependent pathway that promotes a persistent state of immaturity in vitro and in vivo. Proc Natl Acad Sci USA 2001 Jun 5; 98 (12):6800–5.
13- Hughes DA, Norton R. Vitamin D and respiratory health. Clin Exp Immunol. 2009 Oct;158(1):20-25.
14-Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients. 2015 May 29; 7:4240–4270.
15-Holick MF. Vitamin D deficiency. N Engl J Med. 2007 Jul 19;357:266-81.
16-Gallagher JC, Sai AJ. Vitamin D insufficiency, deficiency, and bone health. J Clin Endocrinol Metab. 2010 Jun;95:2630-2633.
17- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20; 382(8):727-733.
18- Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020 Jun;20(6):669-677. doi: 10.1016/S1473-3099(20)30243-7.
19-Hughes DA, Norton R. Vitamin D and respiratory health. Clin Exp Immunol. 2009 Oct; 158(1):20-25.
20- Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017 Feb 15; 356:i6583. doi: 10.1136/bmj.i6583.
21-Mathyssen C, Gayan-Ramirez G, Bouillon R, Janssens W. Vitamin D supplementation in respiratory diseases: evidence from randomized controlled trials. Pol Arch Intern Med. 2017 Nov 30; 127(11):775-784.
22-Monadi M, Heidari B, Asgharpour M, Firouzjahi A, Monadi M, Ghazi Mirsaied M A. Relationship between serum vitamin D and forced expiratory volume in patients with chronic obstructive pulmonary disease (COPD). Caspian J Intern Med. 2012 Summer; 3 (3) :451-455.
23- Gombart AF, Borregaard N, Koeffler HP. Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxyvitamin D3. FASEB J. 2005 Jul; 19(9):1067-77.
24- Dai X, Sayama K, Tohyama M, Shirakata Y, Hanakawa Y, Tokumaru S, et al. PPARγ mediates innate immunity by regulating the 1α,25-dihydroxyvitamin D3 induced hBD-3 and cathelicidin in human keratinocytes. J Dermatol Sci. 2010 Dec; 60(3):179-86.
25-White JH. Vitamin D as an inducer of cathelicidin antimicrobial peptide expression: past, present and future. J Steroid Biochem Mol Biol. 2010 Jul; 121(1-2):234-8.
26- Xie Z, Chen J, Zheng C, Wu J, Cheng Y, Zhu S, et al. 1,25-dihydroxyvitamin D3 -induced dendritic cells suppress experimental autoimmune encephalomyelitis by increasing proportions of the regulatory lymphocytes and reducing T helper type 1 and type 17 cells. Immunology. 2017 Nov; 152(3):414-424.
27- Carpagnano GE, Di Lecce V, Quaranta VN, Zito A, Buonamico E, Capozza E, et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J Endocrinol Invest. 2021 Apr;44(4):765-71
28- Maghbooli Z, Sahraian MA, Ebrahimi M, Pazoki M, Kafan S, Tabriz HM, et al. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PLoS One 2020;15:e0239799
29- Tan CW, Ho LP, Kalimuddin S, Cherng BPZ, Teh YE, Thien SY, et al. A cohort study to evaluate the effect of combination Vitamin D, Magnesium and Vitamin B12 (DMB) on progression to severe outcome in older COVID-19 patients. Nutrition. 2020 Nov-Dec, 111017. doi:10.1101/2020.06.01.20112334.
30- Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020 May; 46(5):846-848.
31- Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Jul; 75(7):1730-1741.
32- Ebadi M, Montano-Loza AJ. Perspective: improving vitamin D status in the management of COVID-19. Eur J Clin Nutr. 2020 Jun;74(6):856-859.
| Files | ||
| Issue | Vol 59, No 11 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v59i11.7779 | |
| Keywords | ||
| Coronavirus disease 2019 (COVID-19) Prognosis Risk factor Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Severity Vitamin D | ||
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How to Cite
1.
Asgari A, Hazrati E, Soleiman-Meigooni S, Rajaeinejad M, Alahyari S, Nasiri M. Vitamin D Insufficiency in Disease Severity and Prognosis of the Patients with SARS Corona Virus-2 Infection. Acta Med Iran. 2021;59(11):662-668.
