Vitamin D Status in Relation to the Clinical Outcome of Hospitalized COVID-19 Patients

Abstract

Coronavirus Disease (COVID-19) is a newly emerged infectious disease that first appeared in China. Vitamin D is a steroid hormone with an anti-inflammatory protective role during viral infections, including SARS-CoV-2 infection, via regulating the innate and adaptive immune responses. The study aimed to investigate the correlation between serum 25-hydroxyvitamin D (25[OH]D) levels and clinical outcomes of COVID-19. This was a retrospective study of 126 COVID-19 patients treated in NMC Royal Hospital, UAE. The mean age of patients was 43 ± 12 years. Eighty three percentage of patients were males, 51% patients were with sufficient (> 20 ng/mL), 41% with insufficient (12–20 ng/mL), and 8% with deficient (<12 ng/mL) serum 25(OH)D levels. There was a statistically significant correlation between vitamin D deficiency and mortality (p = 0.04). There was a statistically significant correlation between 25(OH)D levels and ICU admission (p = 0.03), but not with the need for mechanical ventilation (p = 0.07). The results showed increased severity and mortality by 9 and 13%, respectively, for each one-year increase in age. This effect was maintained after adjustment for age and gender (Model-1) and age, gender, race, and co-morbidities (Models-2,3). 25(OH)D levels (<12 ng/mL) showed a significant increase in mortality by eight folds before adjustments (p = 0.01), by 12 folds in Model-1 (p = 0.04), and by 62 folds in the Model-2. 25(OH)D levels (< 20 ng/mL) showed no association with mortality before adjustment and in Model-1. However, it showed a significant increase in mortality by 29 folds in Model-3. Neither 25(OH)D levels (<12 ng/mL) nor (< 20 ng/mL) were risk factors for severity. Radiological findings were not significantly different among patients with different 25(OH)D levels. Despite observed shorter time till viral clearance and time from cytokine release storm to recovery among patients with sufficient 25(OH)D levels, the findings were statistically insignificant. In conclusion, we demonstrated a significant correlation between vitamin D deficiency and poor COVID-19 outcomes.

Commentary: Vitamin D Status in Relation to the Clinical Outcome of Hospitalized COVID-19 Patients

“…Although the reported findings by Hafez et al ( 1 ) could be partly explained by the protective immunomodulatory effects of vitamin D ( 7 ), also DBP might exert its influence on the outcome of COVID-19 patients. In addition to its unique sterol binding ability and its influence on the concentration of vitamin D metabolites, DBP performs a number of critical biological tasks such as actin scavenging, chemotaxis, macrophage activation, and fatty acid transport, which might explain these observations ( 4 ).…”

“…The observed link between vitamin D deficiency and poor clinical outcomes among COVID-19 patients in the paper of Hafez et al ( 1 ) could be influenced by DBP and its polymorphism. In a previous study, we looked at the impact of DBP phenotypes in patients with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.…”

“…With interest, we read the paper of Hafez et al ( 1 ), which investigated the relationship between vitamin D status and clinical outcome of hospitalized coronavirus disease 2019 (COVID-19) patients. An increased risk for intensive care unit (ICU) admission and in-hospital mortality were associated with (very) low serum 25-hydroxyvitamin D [25(OH)D] concentrations.…”

Commentary: Vitamin D status in relation to the clinical outcome of hospitalized COVID-19 patients

“…While Controversies still persist concerning the plausible role of Vitamin D in COVID-19 disease severity and effect on the outcome; our study demonstrated a significant correlation between severe Vitamin D Deficiency and the risk of a poor disease outcome. We observed a significant link between severe vitamin D deficiency, ICU admission, and COVID-19-related in-hospital mortality (2).…”

Vitamin D and interferon-γ co-operate to increase the ACE-2 receptor expression in primary cultures of human thyroid cells

“…Indeed, cohort studies reported lower VitD levels in SARS-CoV-2-infected patients than in SARS-CoV-2-negative subjects, suggesting a relationship between insufficient VitD levels and SARS-Cov-2 infection [ 5 ]. Interestingly, low VitD levels were also associated with a more severe course of the disease [ 6 , 7 ].…”