USE OF VITAMIN D IN CRITICALLY ILL COVİD-19 PATIENTS

Year 2022, Volume: 8 Issue: 2, 87 - 100, 05.06.2022

İsa Sahar , Nimet Şenoğlu , Kazım Rollas , Taner Çalışkan , İsil Kose , Çiler Zincircioğlu , Aykut Sarıtaş , Uğur Uzun

Abstract

Aim: Coronavirus 19 disease (COVID-19) is the cause of the pandemic that began in Wuhan, China, in December 2019, characterized by severe pulmonary infection and acute respiratory failure. Vitamin D reduces the risk of infections. This study was aimed to evaluate the effect of vitamine D on acute phase reactants, oxygenation and mortality in critically ill COVID-19 patients.
Methods: Patients were retrospectively analyzed between March-December 2020. Eighty-nine patients were included in the study.
Results: Thirty-three patients(37%) received vitamin D, 56 patients(63%) did not. The median age of the patients was 69 years(33-101). Eleven(12,3%) of 21 patients who underwent invasive mechanical ventilation on the first day at ICU stay received vitamin D in the intensive care unit, 10 patients(11,2%) did not. Over the 14 days, procalcitonin, neutrophil/lymphocite ratio, lactate dehydrogenase, did not change in patients who received vitamin D(p=0,78,p=0,19,p=0,11). There was increase in PaO₂/FiO₂ ratio over 14 days in both groups, however, it was distinctly significant in patients who received vitamin D (p<0,001).
Conclusion: In conclusion, there was no difference in the acute phase reactants, the need for mechanical ventilation, the duration of intensive care, hospitalization, and mortality in COVID-19 patients who received vitamin D compared to those who did not. Improvement in oxygenation was more evident in patients who received vitamin D.

Keywords

Vitamin D, Intensive Care, Covid-19, pneumonia, critically illness

USE OF VITAMIN D IN CRITICALLY ILL COVİD-19 PATIENTS

Abstract

Aim: Coronavirus 19 disease (COVID-19) is the cause of the pandemic that began in Wuhan, China, in December 2019, characterized by severe pulmonary infection and acute respiratory failure. Vitamin D reduces the risk of infections. This study was aimed to evaluate the effect of vitamine D on acute phase reactants, oxygenation and mortality in critically ill COVID-19 patients.
Methods: Patients were retrospectively analyzed between March-December 2020. Eighty-nine patients were included in the study.
Results: Thirty-three patients(37%) received vitamin D, 56 patients(63%) did not. The median age of the patients was 69 years(33-101). Eleven(12,3%) of 21 patients who underwent invasive mechanical ventilation on the first day at ICU stay received vitamin D in the intensive care unit, 10 patients(11,2%) did not. Over the 14 days, procalcitonin, neutrophil/lymphocite ratio, lactate dehydrogenase, did not change in patients who received vitamin D(p=0,78,p=0,19,p=0,11). There was increase in PaO₂/FiO₂ ratio over 14 days in both groups, however, it was distinctly significant in patients who received vitamin D (p<0,001).
Conclusion: In conclusion, there was no difference in the acute phase reactants, the need for mechanical ventilation, the duration of intensive care, hospitalization, and mortality in COVID-19 patients who received vitamin D compared to those who did not. Improvement in oxygenation was more evident in patients who received vitamin D.

Keywords

Vitamin D, Intensive Care, Covid-19, pneumonia, critically illness

References

• 1. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017;356:i6583.
• 2. Beard J.A., Bearden A., Striker R. Vitamin D and antiviral state. Journal of clinical virology: the official publication of Pan American Society for Clinical Virology. 2011;(3): 194-200.
• 3. Gunville C.F., Mourani P.M., Ginde A.A. The role of vitamin D in prevention and treatment of infection. Inflammation& allergy drug targets, 2013; 12(4): 239-245.
• 4. Gruber-Bzura, B.M. Vitamin D and Influenza-Prevention or Therapy? Int. J. Mol. Sci. 2018, 19, 2419.
• 5. Schwalfenberg, G.K. A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Mol. Nutr. Food Res. 2011, 55, 96–108.
• 6. Liu, P.T.; Stenger, S.; Li, H.;Wenzel, L.; Tan, B.H.; Krutzik, S.R.; Ochoa, M.T.; Schauber, J.;Wu, K.; Meinken, C.;et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science 2006; 311:1770–1773.
• 7. Adams, J.S.; Ren, S.; Liu, P.T.; Chun, R.F.; Lagishetty, V.; Gombart, A.F.; Borregaard, N.; Modlin, R.L.; Hewison, M. Vitamin d-directed rheostatic regulation of monocyte antibacterial responses. J. Immunol. 2009; 182: 4289–4295.
• 8. Laaksi, I. Vitamin D and respiratory infection in adults. Proc. Nutr. Soc. 2012; 71: 90-97.
• 9. Herr, C.; Shaykhiev, R.; Bals, R. The role of cathelicidin and defensins in pulmonary inflammatory diseases. Expert Opin. Biol. Ther. 2007, 7, 1449–1461.
• 10. Huang, C.; Wang, Y.; Li, X.; Ren, L.; Zhao, J.; Hu, Y.; Zhang, L.; Fan, G.; Xu, J.; Gu, X.; et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020.
• 11. Sharifi, A.; Vahedi, H.; Nedjat, S.; Rafiei, H.; Hosseinzadeh-Attar, M.J. Effect of single-dose injection of vitamin D on immune cytokines in ulcerative colitis patients: A randomized placebo-controlled trial. APMIS. 2019; 127: 681–687.
• 12. Lemire, J.M.; Adams, J.S.; Kermani-Arab, V.; Bakke, A.C.; Sakai, R.; Jordan, S.C. 1,25-Dihydroxyvitamin D3 suppresses human T helper/inducer lymphocyte activity in vitro. J. Immunol. 1985; 134: 3032–3035.
• 13. Rech MA, Hunsaker T, Rodriguez J. Deficiency in 25-hydroxyvitamin D and 30-day mortality in patients with severe sepsis and septic shock. Am J Crit Care 2014;23:e72–9.
• 14. Anwar E, Hamdy G, Taher E, Fawzy E, Abdulattif S, Attia MH. Burden and outcome of vitamin D deficiency among critically ill patients: a prospective study. Nutr Clin Pract 2017; 32: 378–84.
• 15. Meltzer do, best tj, zhang h, vokes t, arora v, solway j. Association of vitamin d deficiency and treatment with covıd-19 incidence. Medrxiv 2020 may 13. Https://doi.org/10.1101/2020. 05.08.20095893 [epub ahead of print].
• 16. D’Avolio A, Avataneo V, Manca A, Cusato J, De Nicolò A, Lucchini R, et al. 25-hhydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2. Nutrients; 2020 9;12. https://doi.org/10.3390/nu12051359 [Epub ahead of print].
• 17. Baktash V, Hosack T, Patel N, Shah S, Kandiah P, Van Den Abbeele K, et al. Vitamin D status and outcomes for hospitalised older patients with COVID-19. PostgradMed J 2020 Aug 27. https://doi.org/10.1136/ postgradmedj-2020-138712 [Epub ahead of print].
• 18. Chen G, Wu D, Guo W et al. Clinical and immunologic features in severe and moderate coronavirus disease 2019. J Clin Invest 2020; 130: 2620–2629.
• 19. Qin C, Zhou L, Hu Z et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020; 71: 762–768.
• 20. Leow L, Simpson T, Cursons R, Karalus N, Hancox RJ. Vitamin D, innate immunity and outcomes in community acquired pneumonia. Respirology 16: 611–616, 2011. doi:10.1111/j.1440-1843.2011.01924.x.
• 21. Remmelts HH, van de Garde EM, Meijvis SC, Peelen EL, Damoiseaux JG, Grutters JC, Biesma DH, Bos WJ, Rijkers GT. Addition of vitamin D status to prognostic scores improves the prediction of outcome in community-acquired pneumonia. Clin Infect Dis 55: 1488–1494, 2012. doi:10.1093/cid/cis751.
• 22. Munshi R, Hussein MH, Toraih EA, Elshazli RM, Jardak C, Sultana N, Youssef MR, Omar M, Attia AS, Fawzy MS, Killackey M, Kandil E, Duchesne J. Vitamin D insufficiency as a potential culprit in critical COVID-19 patients. J Med Virol 93: 733–740, 2021. doi:10.1002/ jmv.26360.