Association of Vitamin D with Severity and Outcome of COVID-19: Clinical and Experimental Evidence

Abstract

Introduction: The role of vitamin in COVID-19 remains controversial. We investigated the association between endogenous vitamin D and the severity of COVID-19 as well as the mechanisms of action of vitamin D supplementation. Methods: 25(OH)D3 in serum was associated with disease severity and outcome in 190 COVID-19 patients. In a COVID-19 animal model using intravenous injection of plasma from patients with COVID-19 ARDS into C57/BL6 mice, mice were treated with 0.25μg human 1,25(OH)D3 or vehicle. Mice were sacrificed on day 4. Cytokines and myeloperoxidase (MPO) in tissues were measured. Changes in gene expression after vitamin D supplementation were measured. Results: Vitamin D deficiency and insufficiency were associated with increased severity and unfavourable outcome after 28 days. Vitamin D levels were negatively associated with biomarkers of COVID-19 severity. Vitamin D supplementation after challenge of mice with COVID-19 plasma led to reduced levels of TNFα, IL-6, IFNγand MPO in the lung, as well as down-regulation of pro-inflammatory pathways. Conclusion: Normal levels of endogenous Vitamin D are associated with reduced severity and risk of unfavourable outcome in COVID-19, possibly through attenuation of tissue-specific hyperinflammation.

Vitamin D Levels in COVID-19 and NonCOVID-19 Pediatric Patients and Its Relationship with Clinical and Laboratory Characteristics

“…The association between NLR and vitamin D is not yet fully understood. The study of Renieris et al [15] and Pimentel et al [51] showed that NLR was inversely associated to vitamin D levels, while Gulcan et al [58] did not identify any correlation between the two parameters.…”

“…Previous studies analyzed the relationship/role of vitamin D levels/supplementation in incidence/severity of respiratory tract infections, including COVID-19 [7][8][9]. Studies regarding the relationship between vitamin D and COVID-19 clinical and laboratory profile or disease outcomes, mainly focused on adult patients and often showed conflicting results [10][11][12][13][14][15][16][17][18][19][20][21][22]. A series of studies identified a negative correlation between vitamin D and NLR and CRP [12,13], while other studies did not identify any correlation between them [14][15][16][17].…”

“…Studies regarding the relationship between vitamin D and COVID-19 clinical and laboratory profile or disease outcomes, mainly focused on adult patients and often showed conflicting results [10][11][12][13][14][15][16][17][18][19][20][21][22]. A series of studies identified a negative correlation between vitamin D and NLR and CRP [12,13], while other studies did not identify any correlation between them [14][15][16][17]. The study of Yarali et al [18] reported that in SARS-CoV-2 infection in children, the leukocytes count was normal, while the study of Yamada et al [19] reported the association between leukocytosis and a poor outcome.…”