Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19

Abstract

Purpose: Hypovitaminosis D is a highly spread condition correlated with increased risk of respiratory tract infections. Nowadays, the world is in the grip of the Coronavirus disease 19 (COVID 19) pandemic. In these patients, cytokine storm is associated with disease severity. In consideration of the role of vitamin D in the immune system, aim of this study was to analyse vitamin D levels in patients with acute respiratory failure due to COVID-19 and to assess any correlations with disease severity and prognosis. Methods: In this retrospective, observational study, we analysed demographic, clinical and laboratory data of 42 patients with acute respiratory failure due to COVID-19, treated in Respiratory Intermediate Care Unit (RICU) of the Policlinic of Bari from March, 11 to April 30, 2020. Results: Eighty one percent of patients had hypovitaminosis D. Based on vitamin D levels, the population was stratified into four groups: no hypovitaminosis D, insufficiency, moderate deficiency, and severe deficiency. No differences regarding demographic and clinical characteristics were found. A survival analysis highlighted that, after 10 days of hospitalization, severe vitamin D deficiency patients had a 50% mortality probability, while those with vitamin D ≥10 had a 5% mortality risk (p=0.019). Conclusions: High prevalence of hypovitaminosis D was found in COVID-19 patients with acute respiratory failure, treated in a RICU. Patients with severe vitamin D deficiency had a significantly higher mortality risk. Severe vitamin D deficiency may be a marker of poor prognosis in these patients, suggesting that adjunctive treatment might improve disease outcomes.

Effects of Vitamin D on COVID-19 Infection and Prognosis: A Systematic Review

“…The nine studies covered 1,005,042 study participants (COVID-19 patients). The number of participants in this study differed from a smaller retrospective observational study in Italy of 42 COVID-19 patients 22 and a larger study involving 1,000,000 study participants 23 in 20 European countries. Regarding study setting, two were conducted in Italy, one in 20 European countries, one in the US, one in the UK, one in Israel, two multinational, and one in Spain.…”

“…Seven (77.8%) articles showed that the status of vitamin D status was related to COVID-19 infection, severity, and death. 22 , 24–28 Two 29 , 30 failed to show an association. This might be because the vitamin D levels in these studies were measured a long ago, before the patients were infected with COVID-19, and might not represent actual vitamin D levels after infection with COVID-19.…”

“… 27 A study at the Policlinico di Bari, Italy among adult inpatients demonstrated that mortality was more common among severely vitamin D–deficient patients (OR 5,681, 95% CI 1,114–28,974; P =0.037). 22 …”

“…Increased age, 22 , 24 , 26 , 28 male sex, 26 , 28 , 29 obesity, overweight, high BMI, 27 , 29 , 30 and presence of comorbidities 24 , 26–28 are recognized risk factors for death and severity among COVID-19 patients. In addition, ethnicity of non-Hispanic black/Hispanic, 24 nonwhite, South Asian, 30 and BAME, 29 higher levels of creatinine, troponin, and IL6, 22 higher Townsend deprivation score, 29 and household overcrowding 29 are independent predictors of severity or mortality among patients with COVID-19 ( Table 2 ).…”

Exploring the link between vitamin D and clinical outcomes in COVID-19

“…Carpagnano et al(9) noticed a high prevalence of low vitamin D among patients admitted to ICU, and the majority of patients in the vitamin D deficiency group of their study were males.We did not find any significant correlation between low vitamin D levels and the development ofnew DVT or PE in COVID-19 patients. This could be, in part, due to the low number of patients in this study who developed new DVT or PE.…”