Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities?

Stagi, Stefano; Rigante, Donato; Lepri, Gemma; Cerinic, Marco Matucci; Falcini, Fabio

doi:10.1007/s10067-015-2970-6

Cited by 47 publications

(56 citation statements)

References 41 publications

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“…As was previously mentioned, vitamin D exerts its anti-inflammatory activity through several ways and its supplementation reduced inflammatory marker including IL-6 and CRP 3) . Another study 29) reported that low vitamin D levels increase coronary artery complications in KD and serum vitamin D concentration is negatively associated with ESR and CRP. However we did not observe any differences in the incidence of coronary artery complications, ESR, or CRP between the 2 groups.…”

Section: Discussionmentioning

confidence: 96%

Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease

2017

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PurposeVitamin D is associated with various pathological conditions such as cardiovascular diseases and cancer. We investigated the relationship between vitamin D and Kawasaki disease (KD).MethodsWe performed a retrospective review of the medical records of patients with KD between February 2013 and March 2016 in Daegu Fatima Hospital. Study participants were grouped according to vitamin D serum concentration. Group 1 included patients with 25(OH)-vitamin D ≥20 ng/mL. Group 2 included patients with 25(OH)-vitamin D <20 ng/mL. We analyzed the clinical characteristics and laboratory data of the 2 groups.ResultsOf the 91 patients, 52 were included in group 1, and 39 in group 2. Group 1 patients had significantly higher levels of calcium, phosphate, albumin and sodium than group 2 patients did. There were no differences in clinical characteristics, but the proportion of patients with polymorphic rash was significantly higher in group 2. Resistance to intravenous immunoglobulin was more frequent in group 2 (P=0.023). No significant difference in the incidence of coronary artery complications was observed.ConclusionLow vitamin D levels are associated with resistance to intravenous immunoglobulin therapy in KD. Vitamin D deficiency might be a risk factor for immunoglobulin resistance in KD.

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Section: Discussionmentioning

confidence: 96%

Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease

2017

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“…This may be the reason for the simultaneous attenuation of CRP and inflammatory cytokines (CD4(+) IFN-γ) in hemodialysis patients after calcitriol treatment [19], or elevation of both CRP and cytokines in severe COVID-19 patients [23]. The relationship between CRP and Vit D has been investigated in multiple clinical studies and demonstrating an inverse correlation between the two variables [16,50]. In the following we investigate the link between CRP and Vit D among different age groups and among subjects with low-income and high-income.…”

Section: Crp and Vit D Deficiency In Healthy Subjectsmentioning

confidence: 99%

The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients

Daneshkhah¹,

Agrawal²,

Eshein³

et al. 2020

Preprint

203

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Objectives To investigate the possible role of Vitamin D (Vit D) deficiency via unregulated inflammation in COVID-19 complications and associated mortality. Design The time-adjusted case mortality ratio (T-CMR) was estimated as the number of deceased patients on day N divided by the number of confirmed cases on day N-8. The adaptive average of T-CMR (A-CMR) was further calculated as a metric of COVID-19 associated mortality in different countries. A model based on positivity change (PC) and an estimated prevalence of COVID-19 was developed to determine countries with similar screening strategies. Mean concentration of 25-hydroxyvitamin D (25(OH)D) in elderly individuals in countries with similar screening strategies were compared to investigate the potential impact of Vit D on A-CMR. We analyzed data showing a possible association between high C-Reactive Protein (CRP) concentration (CRP greater than or equal to 1 mg/dL) and severe COVID-19. We estimated a link between Vit D status and high CRP in healthy subjects (CRP greater than or equal to 0.2 mg/dL) with an adjustment for age and income to explore the possible role of Vit D in reducing complications attributed to unregulated inflammation and cytokine production. Data Sources Daily admission, recovery, and deceased rate data for patients with COVID-19 were collected from Kaggle as of April 20, 2020. Screening data were collected from Our World in Data and official statements from public authorities. The mean concentration of 25(OH)D among the elderly for comparison with A-CMR was collected from previously published studies from different countries. Chronic factor data used in regression analysis was obtained from published articles. The correlation between Vit D and CRP was calculated based on 9,212 subject-level data from NHANES, 2009-2010. Results A link between 25(OH)D and A-CMR in the US, France, Iran and the UK (countries with similar screening status) may exist. We observed an inverse correlation (correlation coefficient ranging from -0.84 to -1) between high CRP and 25(OH)D. Age and the family income status also correlated to high CRP and subjects with higher age and lower family income presented more incidences of high CRP. Our analysis determined a possible link between high CRP and Vit D deficiency and calculated an OR of 1.8 with 95%CI (1.2 to 2.6) among the elderly (age greater than or equal to 60 yo) in low-income families and an OR of 1.9 with 95%CI (1.4 to 2.7) among the elderly (age greater than or equal to 60 yo) in high-income families. COVID-19 patient-level data shows a notable OR of 3.4 with 95%CI (2.15 to 5.4) for high CRP in severe COVID-19 patients. Conclusion Given that CRP is a surrogate marker for cytokine storm and is associated with Vit D deficiency, based on retrospective data and indirect evidence we see a possible role of Vit D in reducing complications attributed to unregulated inflammation and cytokine storm. Further research is needed to account for other factors through direct measurement of Vit D levels in COVID-19 patients.

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“…8 Kawasaki syndrome, currently being reported with increasing incidence while countries are in 'lockdown', also has a winter predominance and here too a causative role for vitamin D deficiency has been suggested. 9 All the associations between vitamin D deficiency and COVID-19 severity are circumstantial but they are stacking up and obtaining more direct evidence will not be easy. If low serum vitamin D levels are found in patients with severe COVID-19 these could reasonably be attributed to the well-recognised negative acute phase reactant response of vitamin D to illness.…”

Section: Editorsmentioning

confidence: 99%

Letter: low population mortality from COVID‐19 in countries south of latitude 35° North supports vitamin D as a factor determining severity. Authors’ reply

Rhodes

Subramanian

Laird³

et al. 2020

Aliment Pharmacol Ther

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Severe vitamin D deficiency in patients with Kawasaki disease: a potential role in the risk to develop heart vascular abnormalities?

Cited by 47 publications

References 41 publications

Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease

Relationship between vitamin D levels and intravenous immunoglobulin resistance in Kawasaki disease

The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients

Letter: low population mortality from COVID‐19 in countries south of latitude 35° North supports vitamin D as a factor determining severity. Authors’ reply

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