2022 Vitamin D Levels & Severity in Illness
Apr 30, 2022 19:20:55 GMT
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Post by deborah on Apr 30, 2022 19:20:55 GMT
The Relationship Between Vitamin D Levels and Severity in Illness in COVID-19 Patients: A Cross-Sectional Study
Published: March 14, 2022
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Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic hit the world badly with high mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increased the COVID-19 burden among developed and developing countries due to the unavailability of proven treatment options. Vitamin D has many important anti-inflammatory, immunomodulator, and anti-viral functions. The present study was conducted to evaluate the relationship between Vitamin D in COVID-19.
Methods: A cross-sectional study was conducted at a tertiary care hospital in Patna, India. All the patients were enrolled during the period of 3.5 months. A chemiluminescence-based immunoassay analyzer was used to quantify Vitamin D among COVID-19 patients. The study compared Vitamin D deficiency and insufficiency among different groups, i.e., age, sex, BMI, comorbidity, etc. Diabetes and hypertension were evaluated as risk factors for mortality.
Results: A total of 225 patients were investigated. Of these, 13.6% had Vitamin D deficiency and 38.9% had insufficiency. Vitamin D level was statistically significant among different age groups, sex, and smokers. Patients aged >60 years were 23 times more likely to have a severe illness (adjusted OR (aOR) 23.53, 95%CI 4.67-118.61), whereas those aged 40 to 60 years were 11 times more likely to have a severe illness (aOR 10.86, 95%CI 2.39-49.31). Patients with many comorbidities, on the other hand, had a tenfold greater chance of severe COVID-19 (aOR 9.94, 95%CI 2.47-39.88). A deficiency of vitamin D increased the chance of a serious illness by nearly five times (aOR 4.72, 95%CI 1.31-17.03).
Discussion
In the current study, we discovered a significant link between a low level of Vitamin D and the risk of contracting SARS-CoV-2, supported by previous research that found Vitamin D had protective effects against respiratory distress. Additionally, a study suggested that increasing Vitamin D intake has been related to a diminished danger of upper or lower respiratory tract infections (RTIs). Vitamin D's possible role in viral infections like SARS-CoV-2 is clarified by its role in sustaining resistance and immunity. Vitamin D may also aid in the treatment of COVID-19 by preventing hypercytokinemia and the accompanying acute respiratory distress syndrome, which is generally the cause of high fatality rates [15].
Different studies from 2007 to 2020 revealed that Vitamin D had protecting effects against many acute respiratory issues, although these were of minimal quantity and lesser importance [16]. The unique link between COVID-19 risk factors and Vitamin D insufficiency includes obesity, old age, ethnicity of Asian origin or Black, and these linkages have led to the conclusion that supplementing one’s diet with Vitamin D can help one avoid or treat the illness efficiently. Moreover, it would not be wrong to say that there are chances that Vitamin D positively modifies host response to ARDS in the case of COVID-19 [17]. It does so in both phases when there is early infection by SARS-CoV-2 or an inflammatory phase [18].
In those who are neither obese nor old, there has also been a link between getting sufficient Vitamin D and having a lower COVID-19 death rate. The polymorphism of Vitamin D and its Vitamin D Binding Protein (DBP) has been discovered to have a great relationship. The DBP has three alleles, out of which amount of Vitamin D was found to be highest among DBP1-1, medium among DBP1-2, and lower among DBP2-2, in females who were white and premenopausal [17]. Furthermore, an elevated concentration of actin is detected in ARDS patients, which is one of the symptoms in COVID-19 patients, leading to angiopathy, micro-embolisms, and organ failure. Vitamin D binding protein has the function of scavenging actin to destroy it extracellularly and prevent its accumulation in the circulation. A lower level of Vitamin D binding protein in plasma shows a poor survival rate. Although DBP and actin complexes have no effects, they may also show a function similar to cytokine storm. The E-value for the outcomes linked with Vitamin D concentration and COVID-19 was determined in research. On the odds ratio scale, the result indicated minor impacts. It was determined that an odds ratio of at least 8.6 to 10.6 was required to eliminate the link between Vitamin D deficiency and ARDS in patients over the age of 65, and mortality in patients with a BMI less than 30.
Vitamin D metabolites have, for quite some time, been known to help inborn anti-viral effector components, along with enlistment of antibacterial peptides as well as autophagy [19]. Research information identifying with impacts of Vitamin D on COVID-19 is scant; however, one investigation has found that the active form of Vitamin D has an antiviral effect when tested, i.e., 1,25 dihydroxy Vitamin D in the epithelial cells of the nose that are tainted with COVID-19. It has also been appeared to control immune-pathological inflammation-causing reactions to other respiratory tract diseases. The renin-angiotensin framework that intervened with these impacts in animal testing has specific importance regarding extreme infection with SARS-CoV-2, in which the renin-angiotensin system was found to be overactive, resulting in a dismal or unfavorable prognosis [20]. Research showed that people having Vitamin D deficiency had 80% more chances to get infected, similar to our research results that show the disease severity increasing with deficient Vitamin D [21]. Out of a total of 13.6% of patients deficient in Vitamin D, 36.7% showed severity with a p-value of 0.001. While with optimal levels of Vitamin D, i.e., 47.5%, patients getting towards severity were only 10.3%.
A review consisting of many studies showed aspects of nutritional value and its status among the elderly, including impact on infection from SARS-CoV-2. There was a high prevalence rate among the elderly with undernutrition suffering from COVID-19. It showed more links with negative consequences, including higher death rates and more shifting towards intense care units. There were decreased levels of Vitamin D and other nutrients such as magnesium, albumin, zinc, etc. These resulted in more need for oxygen therapy and intense care unit transfers to cope with decreasing survival rates [22]. The study concluded that more care must be provided to the elderly population so that there is lesser malnutrition and thus more chances of survival from COVID-19. Our study showed that out of 18% (n=41) of patients with ages > 60, 17.1% (n=7) were deficient in Vitamin D. As per our study findings, a total of 5.8% (n=13) were underweight, amongst them 46.2% showed an insufficient amount of Vitamin D, and 53.8% had optimal average amount, and 0% had deficiency regardless of age.
A research study was conducted to determine the effects of Vitamin D taken six months before infection [23]. All data related to the inflammatory status, Vitamin D deficiency, and other clinical values were considered. Two groups were made, and patients were divided into having Vitamin D quantity lower than 20ng/ml and more than 20ng/ml, respectively [24]. The group with lesser levels of Vitamin D, i.e., <20ng/ml, showed decreased leukocyte (p=0.021) and hemoglobin (p=o.035) levels and higher amounts of C-reactive protein(CRP). Moreover, people who did not take Vitamin D supplementation before six months showed more chances of pneumonia than those who took Vitamin D. A range of aspects might affect DBP and levels of Vitamin D like obesity, chronic kidney and liver disease, carcinoma, CAD, asthma, diabetes, and HTN [25]. Vitamin D deficit and insufficiency were linked to illness severity and death in our research, and both were statistically significant. Diabetes and HTN, and other comorbidities, played an important role in severity and mortality, with statistically significant results among COVID-19 patients.
Another study discovered a link between vitamin D levels and parathyroid hormone levels (PTH). After validated PCR testing and diagnosis, 109 individuals ranging in age from 14 to 58 years were enrolled in the research. After eight weeks, abnormal vitamin D levels were discovered, as well as an increase in the amount of PTH. Those were the patients who needed intense care treatment; however, the low levels of Vitamin D were not linked to disease severity, i.e., lung functions and other outcomes. However, there was an abnormal relationship between Vitamin D and PTH concentrations during their phases of recovery [26].
Vitamin D can have various effects in our body, ranging from inactivating the viral pathogens by regulating the functions of antibacterial peptides, thus inhibiting the process of replication. It also activates the phagocytes, thus acting as a protective barrier for the respiratory tract. It also suppresses the process of inflammation by having a role in the making of cytokines and helper T-17 cells, thus providing a healthy environment for the proper functioning of the respiratory tract and the whole body [27].
Published: March 14, 2022
link
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic hit the world badly with high mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increased the COVID-19 burden among developed and developing countries due to the unavailability of proven treatment options. Vitamin D has many important anti-inflammatory, immunomodulator, and anti-viral functions. The present study was conducted to evaluate the relationship between Vitamin D in COVID-19.
Methods: A cross-sectional study was conducted at a tertiary care hospital in Patna, India. All the patients were enrolled during the period of 3.5 months. A chemiluminescence-based immunoassay analyzer was used to quantify Vitamin D among COVID-19 patients. The study compared Vitamin D deficiency and insufficiency among different groups, i.e., age, sex, BMI, comorbidity, etc. Diabetes and hypertension were evaluated as risk factors for mortality.
Results: A total of 225 patients were investigated. Of these, 13.6% had Vitamin D deficiency and 38.9% had insufficiency. Vitamin D level was statistically significant among different age groups, sex, and smokers. Patients aged >60 years were 23 times more likely to have a severe illness (adjusted OR (aOR) 23.53, 95%CI 4.67-118.61), whereas those aged 40 to 60 years were 11 times more likely to have a severe illness (aOR 10.86, 95%CI 2.39-49.31). Patients with many comorbidities, on the other hand, had a tenfold greater chance of severe COVID-19 (aOR 9.94, 95%CI 2.47-39.88). A deficiency of vitamin D increased the chance of a serious illness by nearly five times (aOR 4.72, 95%CI 1.31-17.03).
Discussion
In the current study, we discovered a significant link between a low level of Vitamin D and the risk of contracting SARS-CoV-2, supported by previous research that found Vitamin D had protective effects against respiratory distress. Additionally, a study suggested that increasing Vitamin D intake has been related to a diminished danger of upper or lower respiratory tract infections (RTIs). Vitamin D's possible role in viral infections like SARS-CoV-2 is clarified by its role in sustaining resistance and immunity. Vitamin D may also aid in the treatment of COVID-19 by preventing hypercytokinemia and the accompanying acute respiratory distress syndrome, which is generally the cause of high fatality rates [15].
Different studies from 2007 to 2020 revealed that Vitamin D had protecting effects against many acute respiratory issues, although these were of minimal quantity and lesser importance [16]. The unique link between COVID-19 risk factors and Vitamin D insufficiency includes obesity, old age, ethnicity of Asian origin or Black, and these linkages have led to the conclusion that supplementing one’s diet with Vitamin D can help one avoid or treat the illness efficiently. Moreover, it would not be wrong to say that there are chances that Vitamin D positively modifies host response to ARDS in the case of COVID-19 [17]. It does so in both phases when there is early infection by SARS-CoV-2 or an inflammatory phase [18].
In those who are neither obese nor old, there has also been a link between getting sufficient Vitamin D and having a lower COVID-19 death rate. The polymorphism of Vitamin D and its Vitamin D Binding Protein (DBP) has been discovered to have a great relationship. The DBP has three alleles, out of which amount of Vitamin D was found to be highest among DBP1-1, medium among DBP1-2, and lower among DBP2-2, in females who were white and premenopausal [17]. Furthermore, an elevated concentration of actin is detected in ARDS patients, which is one of the symptoms in COVID-19 patients, leading to angiopathy, micro-embolisms, and organ failure. Vitamin D binding protein has the function of scavenging actin to destroy it extracellularly and prevent its accumulation in the circulation. A lower level of Vitamin D binding protein in plasma shows a poor survival rate. Although DBP and actin complexes have no effects, they may also show a function similar to cytokine storm. The E-value for the outcomes linked with Vitamin D concentration and COVID-19 was determined in research. On the odds ratio scale, the result indicated minor impacts. It was determined that an odds ratio of at least 8.6 to 10.6 was required to eliminate the link between Vitamin D deficiency and ARDS in patients over the age of 65, and mortality in patients with a BMI less than 30.
Vitamin D metabolites have, for quite some time, been known to help inborn anti-viral effector components, along with enlistment of antibacterial peptides as well as autophagy [19]. Research information identifying with impacts of Vitamin D on COVID-19 is scant; however, one investigation has found that the active form of Vitamin D has an antiviral effect when tested, i.e., 1,25 dihydroxy Vitamin D in the epithelial cells of the nose that are tainted with COVID-19. It has also been appeared to control immune-pathological inflammation-causing reactions to other respiratory tract diseases. The renin-angiotensin framework that intervened with these impacts in animal testing has specific importance regarding extreme infection with SARS-CoV-2, in which the renin-angiotensin system was found to be overactive, resulting in a dismal or unfavorable prognosis [20]. Research showed that people having Vitamin D deficiency had 80% more chances to get infected, similar to our research results that show the disease severity increasing with deficient Vitamin D [21]. Out of a total of 13.6% of patients deficient in Vitamin D, 36.7% showed severity with a p-value of 0.001. While with optimal levels of Vitamin D, i.e., 47.5%, patients getting towards severity were only 10.3%.
A review consisting of many studies showed aspects of nutritional value and its status among the elderly, including impact on infection from SARS-CoV-2. There was a high prevalence rate among the elderly with undernutrition suffering from COVID-19. It showed more links with negative consequences, including higher death rates and more shifting towards intense care units. There were decreased levels of Vitamin D and other nutrients such as magnesium, albumin, zinc, etc. These resulted in more need for oxygen therapy and intense care unit transfers to cope with decreasing survival rates [22]. The study concluded that more care must be provided to the elderly population so that there is lesser malnutrition and thus more chances of survival from COVID-19. Our study showed that out of 18% (n=41) of patients with ages > 60, 17.1% (n=7) were deficient in Vitamin D. As per our study findings, a total of 5.8% (n=13) were underweight, amongst them 46.2% showed an insufficient amount of Vitamin D, and 53.8% had optimal average amount, and 0% had deficiency regardless of age.
A research study was conducted to determine the effects of Vitamin D taken six months before infection [23]. All data related to the inflammatory status, Vitamin D deficiency, and other clinical values were considered. Two groups were made, and patients were divided into having Vitamin D quantity lower than 20ng/ml and more than 20ng/ml, respectively [24]. The group with lesser levels of Vitamin D, i.e., <20ng/ml, showed decreased leukocyte (p=0.021) and hemoglobin (p=o.035) levels and higher amounts of C-reactive protein(CRP). Moreover, people who did not take Vitamin D supplementation before six months showed more chances of pneumonia than those who took Vitamin D. A range of aspects might affect DBP and levels of Vitamin D like obesity, chronic kidney and liver disease, carcinoma, CAD, asthma, diabetes, and HTN [25]. Vitamin D deficit and insufficiency were linked to illness severity and death in our research, and both were statistically significant. Diabetes and HTN, and other comorbidities, played an important role in severity and mortality, with statistically significant results among COVID-19 patients.
Another study discovered a link between vitamin D levels and parathyroid hormone levels (PTH). After validated PCR testing and diagnosis, 109 individuals ranging in age from 14 to 58 years were enrolled in the research. After eight weeks, abnormal vitamin D levels were discovered, as well as an increase in the amount of PTH. Those were the patients who needed intense care treatment; however, the low levels of Vitamin D were not linked to disease severity, i.e., lung functions and other outcomes. However, there was an abnormal relationship between Vitamin D and PTH concentrations during their phases of recovery [26].
Vitamin D can have various effects in our body, ranging from inactivating the viral pathogens by regulating the functions of antibacterial peptides, thus inhibiting the process of replication. It also activates the phagocytes, thus acting as a protective barrier for the respiratory tract. It also suppresses the process of inflammation by having a role in the making of cytokines and helper T-17 cells, thus providing a healthy environment for the proper functioning of the respiratory tract and the whole body [27].