Vitamin D Deficiency and Outcome of COVID-19 Patients

Radujkovic, Aleksandar; Hippchen, Theresa; Tiwari‐Heckler, Shilpa; Dreher, Saida; Boxberger, Monica; Merle, Uta

doi:10.3390/nu12092757

Cited by 383 publications

(341 citation statements)

References 22 publications

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“…We did not find any relationship between serum 25OHD levels and the parameters of COVID-19 severity, such as ICU admission, the need for mechanical ventilation, or mortality, assessed as a combined endpoint or separately. In contrast to other studies ( 31 , 32 ), we did not find an association between serum 25OHD levels and the severity of the disease. However, it cannot be completely ruled out due to the small number of events and the statistical power of the present study.…”

Section: Discussioncontrasting

confidence: 99%

Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection

Hernández

Nan

Fernández-Ayala

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

252

294

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Background The role of vitamin D status in COVID-19 patients is a matter of debate. Objectives To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19 and to analyze the possible influence of vitamin D status on disease severity. Methods Retrospective case–control study of 216 COVID-19 patients and 197 population-based controls. Serum 25OHD levels were measured in both groups. The association of serum 25OHD levels with COVID-19 severity (admission to the intensive care unit, requirements for mechanical ventilation, or mortality) was also evaluated. Results Of the 216 patients, 19 were on vitamin D supplements and were analyzed separately. In COVID-19 patients, mean ± standard deviation 25OHD levels were 13.8 ± 7.2 ng/mL, compared with 20.9 ± 7.4 ng/mL in controls (P < .0001). 25OHD values were lower in men than in women. Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of population-based controls (P < .0001). 25OHD inversely correlates with serum ferritin (P = .013) and D-dimer levels (P = .027). Vitamin D-deficient COVID-19 patients had a greater prevalence of hypertension and cardiovascular diseases, raised serum ferritin and troponin levels, as well as a longer length of hospital stay than those with serum 25OHD levels ≥20 ng/mL. No causal relationship was found between vitamin D deficiency and COVID-19 severity as a combined endpoint or as its separate components. Conclusions 25OHD levels are lower in hospitalized COVID-19 patients than in population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.

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Section: Discussioncontrasting

confidence: 99%

Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection

Hernández

Nan

Fernández-Ayala

et al. 2020

The Journal of Clinical Endocrinology &Amp; Metabolism

252

294

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“…This is an important consideration as acute illnesses, including COVID-19, may affect blood 25(OH)D levels (228). This concept is supported by findings of 10 studies in which vitamin D deficiency or lower 25(OH)D levels in blood were associated with more severe outcomes in people already diagnosed with COVID-19 (202,204,205,208,209,214,216,218,221,222) (see Table 1B). Other limitations for some studies include a lack of adjustment for differences in gender, age and comorbidities, and that COVID-19 diagnoses did not necessarily include a positive PCR result for SARS-CoV-2.…”

Section: Vitamin D Status and Covid-19mentioning

confidence: 72%

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Gorman

Weller

2020

Front. Cardiovasc. Med.

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During the COVID-19 (coronavirus disease of 2019) pandemic, researchers have been seeking low-cost and accessible means of providing protection from its harms, particularly for at-risk individuals such as those with cardiovascular disease, diabetes and obesity. One possible way is via safe sun exposure, and/or dietary supplementation with induced beneficial mediators (e.g., vitamin D). In this narrative review, we provide rationale and updated evidence on the potential benefits and harms of sun exposure and ultraviolet (UV) light that may impact COVID-19. We review recent studies that provide new evidence for any benefits (or otherwise) of UV light, sun exposure, and the induced mediators, vitamin D and nitric oxide, and their potential to modulate morbidity and mortality induced by infection with SARS-CoV-2 (severe acute respiratory disease coronavirus-2). We identified substantial interest in this research area, with many commentaries and reviews already published; however, most of these have focused on vitamin D, with less consideration of UV light (or sun exposure) or other mediators such as nitric oxide. Data collected to-date suggest that ambient levels of both UVA and UVB may be beneficial for reducing severity or mortality due to COVID-19, with some inconsistent findings. Currently unresolved are the nature of the associations between blood 25-hydroxyvitamin D and COVID-19 measures, with more prospective data needed that better consider lifestyle factors, such as physical activity and personal sun exposure levels. Another short-coming has been a lack of measurement of sun exposure, and its potential to influence COVID-19 outcomes. We also discuss possible mechanisms by which sun exposure, UV light and induced mediators could affect COVID-19 morbidity and mortality, by focusing on likely effects on viral pathogenesis, immunity and inflammation, and potential cardiometabolic protective mechanisms. Finally, we explore potential issues including the impacts of exposure to high dose UV radiation on COVID-19 and vaccination, and effective and safe doses for vitamin D supplementation.

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“…A study from Heidelberg, Germany has reported on 185 consecutive SARS-CoV-2 positive patients on a prospective non-interventional register [ 71 ]. Serum 25(OH)D was measured retrospectively in samples collected and frozen at time of admission to the study.…”

Section: Preliminary Evidence Of Associations Between Vitamin D Statumentioning

confidence: 99%

Vitamin D and COVID-19: evidence and recommendations for supplementation

et al. 2020

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Vitamin D is a hormone that acts on many genes expressed by immune cells. Evidence linking vitamin D deficiency with COVID-19 severity is circumstantial but considerable—links with ethnicity, obesity, institutionalization; latitude and ultraviolet exposure; increased lung damage in experimental models; associations with COVID-19 severity in hospitalized patients. Vitamin D deficiency is common but readily preventable by supplementation that is very safe and cheap. A target blood level of at least 50 nmol l −1 , as indicated by the US National Academy of Medicine and by the European Food Safety Authority, is supported by evidence. This would require supplementation with 800 IU/day (not 400 IU/day as currently recommended in UK) to bring most people up to target. Randomized placebo-controlled trials of vitamin D in the community are unlikely to complete until spring 2021—although we note the positive results from Spain of a randomized trial of 25-hydroxyvitamin D3 (25(OH)D3 or calcifediol) in hospitalized patients. We urge UK and other governments to recommend vitamin D supplementation at 800–1000 IU/day for all, making it clear that this is to help optimize immune health and not solely for bone and muscle health. This should be mandated for prescription in care homes, prisons and other institutions where people are likely to have been indoors for much of the summer. Adults likely to be deficient should consider taking a higher dose, e.g. 4000 IU/day for the first four weeks before reducing to 800 IU–1000 IU/day. People admitted to the hospital with COVID-19 should have their vitamin D status checked and/or supplemented and consideration should be given to testing high-dose calcifediol in the RECOVERY trial. We feel this should be pursued with great urgency. Vitamin D levels in the UK will be falling from October onwards as we head into winter. There seems nothing to lose and potentially much to gain.

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Vitamin D Deficiency and Outcome of COVID-19 Patients

Cited by 383 publications

References 22 publications

Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection

Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Vitamin D and COVID-19: evidence and recommendations for supplementation

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