The Effect of Vitamin B12 Levels on Prognosis in COVID-19 Patients

Abstract

Objectives: It is known that vitamins have some effects such as suppressing viral replication, developing anti-inflammatory responses and that they increase immunity in COVID-19. This study aimed to investigate the correlation between the vitamin B12 (Vit B12) serum levels and the prognosis of the disease in patients with COVID-19. Material and Method: A total of 408 participants were included in the study. Sociodemographic information such as age, educational status, serum vitamin B12 levels, hemogram parameters, and clinical findings of the patients who were admitted for follow-up after the end of COVID-19 infection was evaluated retrospectively. Serum vitamin B12 level between 150-200 pg/mL was assessed as mild deficiency, the value between 100-150 pg/mL as severe deficiency and the value under 100 pg/mL as extremely severe deficiency. Results: Median age of the participants was 44.51 (18-88) years. The median Vit B12 level of the patients was 179.50 (75-641). Of the patients, 248 (60.70%) had Vit B12 deficiency. The rates of pneumonia and hospitalization were higher and fatigue and loss of taste/smell were more in patients with Vit B12 deficiency. NLR and PLR which are the inflammatory markers were higher in patients with Vit B12 deficiency. The rates of pneumonia and hospitalization were the highest in the severe Vit B12 deficiency group among the Vit B12 deficiency groups. Conclusion: The clinical progression was worse in COVID-19 patients with Vit B12 deficiency than those who had no Vit B12 deficiency. Therefore, it has been concluded that Vitamin B12 supplement can have positive effects on COVID-19 patients; however, more comprehensive further studies with longer duration and higher number of patients are needed.

Keywords

• COVID-19
• vitamin B12
• inflammation
• prognosis

COVID-19 Hastalarında Vitamin B12 Düzeyinin Prognoz Üzerine Etkisi

Abstract

Amaç: Vitaminlerin, Koronavirüs Hastalığında (COVID-19) viral replikasyonu bozma, anti-inflamatuar yanıt geliştirme gibi etkileri olduğu ve immüniteyi artırdıkları bilinmektedir. Bu çalışmada, COVID-19 hastalarında Vitamin B12 (Vit B12) serum seviyeleri ve hastalığın prognozu arasındaki ilişkiyi görmeyi amaçladık. Gereç ve Yöntem: Çalışmaya COVID-19 enfeksiyonu geçiren 408 katılımcı dâhil edildi. Hastaların yaş, eğitim durumu gibi sosyodemografik bilgileri, serum Vit B12 düzeyleri, hemogram parametreleri, klinik bulguları retrospektif olarak incelendi. Serum B12 vitamini düzeyi 200-2000 normal, 150-200 pg/mL arası hafif eksiklik, 100-150 pg/mL arası ağır eksiklik 100 pg/mL’niın altı ise çok ağır eksiklik olarak gruplandırıldı. Bulgular: Katılımcıların yaş ortancası 44.51(18-88), Vit B12 düzeyi ortancası ise 179.50 ng/L (75-641) idi. Hastaların 248 (%60.78)’inde Vit B12 eksikliği vardı. Ağır Vit B12 eksikliği olan hastalarda ve çok ağır Vit B12 eksikliği olanlarda ateş, diğer gruplardan daha fazlaydı. Benzer şekilde öksürük, tat ve koku kaybı, baş ağrısı. pnömöni ve hospitalizasyon oranı daha yüksekti (P<0.01). Gruplar arasında platelet, nötrofil sayıları açısından anlamlı farklılık vardı. Vit B12 düzeyi normal oranlara göre hafif ve ağır Vit B12 düzeyi olan hastaların platetet sayısından daha yüksekti(p<0.01) Ağır Vit B12 eksikliği olanların nötrofil düzeyleri normal Vit B12 düzeyine sahip hastalardan daha yüksekti (p<0.01). Sonuç: Vit B12 düzeyi eksik olan COVID-19 hastalarının klinik progresyonunun Vit B12 eksikliği olmayanlardan daha kötü olduğu belirlendi. Bu nedenle COVID-19 hastalarında Vit B12 takviyesinin olumlu etkisi olabileceği, ancak bu konuda daha uzun süreli ve daha fazla hasta ile kapsamlı çalışmaların yapılması gerekmektedir.

Keywords

• COVID-19
• vitamin B12
• inflamasyon
• prognoz

References

1. 1. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395(10223):507–13.
2. 2. Herrmann W, Obeid R. Causes and early diagnosis of vitamin B12 deficiency. Dtsch Arztebl Int. 2008;105(40):680-5.
3. 3. Maggini S, Pierre A, Calder PC. Immune Function and Micronutrient Requirements Change over the Life Course. Nutrients 2018;10(10):1531.
4. 4. Gombart AF, Pierre A, Maggini S. A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection. Nutrients 2020;12(1):236.
5. 5. Samad N, Sodunke TE, Abubakar AR, et al. The Implications of Zinc Therapy in Combating the COVID-19 Global Pandemic. J Inflamm Res 2021;14:527-50.
6. 6. Im JH, Je YS, Baek J, Chung MH, Kwon HY, Lee JS. Nutritional status of patients with COVID-19. Int J Infect Dis 2020;100:390-3
7. 7. Galmés S, Serra F, Palou A. Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework. Nutrients 2020;12(9):2738.
8. 8. Tan CW, Ho LP, Kalimuddin S, et al. Cohort study to evaluate the effect of vitamin D, magnesium, and vitamin B12 in combination on progression to severe outcomes in older patients with coronavirus (COVID-19). Nutrition 2020;79-80:111017.

9. 9. Tuna F, Kayalar G. Vitaminler, destek tedaviler ve COVID-19. Ayhan FF, Demirbağ Kabayel D, editörler. COVID-19 Pandemisi ve Fiziksel Tıp ve Rehabilitasyon. 1. Baskı. Ankara: Türkiye Klinikleri; 2020. p.83-8.
10. 10. Dos Santos LMJ. Can vitamin B12 be an adjuvant to COVID‐19 treatment?. GSC Biol Pharm Sci 2020;11:(3):1‐5.
11. 11. Emen B, Eren MA, Özdemir E ve ark. B12 Vitamin eksikliği bulunan hastalarda etiyolojik faktörler ile laboratuvar verileri arasındaki ilişkinin geriye dönük değerlendirilmesi. Tepecik Eğit Hast Derg 2013; 23 (1): 19-23.
12. 12. Narayanan N, Nair DT. Vitamin B12 may inhibit RNA-dependent-RNA polymerase activity of nsp12 from the SARS-CoV-2 virus. IUBMB Life 2020;72(10):2112-20.
13. 13. Shakeri H, Azimian A, Ghasemzadeh-Moghaddam H, et al. Evaluation of the relationship between serum levels of zinc, vitamin B12, vitamin D, and clinical outcomes in patients with COVID-19. J Med Virol 2022;94(1):141-146.
14. 14. Aslaner H. Vitamin B12 Eksikliği ve Tedavisi. Klinik Tıp Aile Hekimliği, 10.6: 18-24.
15. 15. Nguyen HC, Nguyen MH, Do BN, et al. People with Suspected COVID-19 Symptoms Were More Likely Depressed and Had Lower Health-Related Quality of Life: The Potential Benefit of Health Literacy. J Clin Med 2020;9(4):965.
16. 16. Karaca B. Erişkin Yaş Grubunda COVID-19 Klinik Bulguları. J Biotechnol and Strategic Health Res 2020;1(Özel Sayı):85-90.
17. 17. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020;77(6):683-90.
18. 18. Meng X, Deng Y, Dai Z, Meng Z. COVID-19 and anosmia: A review based on up-to-date knowledge. Am J Otolaryngol 2020;41(5):102581.
19. 19. Wolffenbuttel BHR, Wouters HJCM, Heiner-Fokkema MR, van der Klauw MM. The Many Faces of Cobalamin (Vitamin B12) Deficiency. Mayo Clin Proc Innov Qual Outcomes 2019;3(2):200-214.
20. 20. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
21. 21. Li T, Lu H, Zhang W. Clinical observation and management of COVID-19 patients. Emerg Microbes Infect 2020;9(1):687-90.
22. 22. Rayes J, Bourne JH, Brill A, Watson SP. The dual role of platelet-innate immune cell interactions in thrombo-inflammation. Res Pract Thromb Haemost 2019;4(1):23-35.
23. 23. Qu R, Ling Y, Zhang YH, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol 2020;92(9):1533-41.