THE RELATION BETWEEN SEVERITY OF COVID-19 DISEASE AND VITAMIN D LEVEL IN CHILDREN

Abstract

Objective: It is suggested that vitamin D regulates the immune response in infectious and autoimmune diseases. In our study, we aimed to compare vitamin D levels in pediatric patients with severity of COVID-19 disease and a healthy control group. Material and Methods: Retrospectively, we compared the serum vitamin D levels in patients between 1 month and 18 years of age who were followed up with the diagnosis of COVID-19 in the pediatric intensive care unit (PICU) and pediatric ward of Necip Fazıl City Hospital with as a control group healthy children who outpatient between March 2020 and November 2020. Results: Fifteen pediatric patients hospitalized in the COVID PICU and 25 pediatric patients hospitalized in the COVID pediatric service and 40 children in the healthy control group were included. Vitamin D level in PICU was found to be lower than inward median (min-max) was 11.69 (3-27) ng/mL vs 20.8 (6.3-36.8) ng/mL (p=0.005). Conclusion: In our study, we showed that vitamin D deficiency may be a risk factor for having severe COVID-19 disease. Vitamin D supplementation can help the treatment of severe clinical disease COVID-19 by balancing the immune system and response to infection.

Keywords

• Child
• COVID-19
• pandemics
• vitamin D

Çocuklarda COVİD-19 Şiddeti ile D Vitamini Arasındaki İlişki

Abstract

Amaç: Koronavirüs hastalığı-2019 (COVİD-19) pandemisi küresel olarak büyük bir halk sağlığı sorunu oluşturmaktadır. D vitamininin enfeksiyöz ve otoimmün hastalıklarda bağışıklık yanıtını düzenlediği ileri sürülmektedir. Çalışmamızda COVİD-19 hastalığını hafif, orta ve ağır klinik tabloda geçiren çocuk hastalarda ve sağlıklı kontrol grubunda D vitamini düzeylerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Retrospektif olarak Mart 2020 ve Kasım 2020 tarihleri arasında Necip Fazıl Şehir Hastanesi’ nde Çocuk Yoğun Bakım Ünitesi’ nde ve Çocuk Sağlığı ve Hastalıkları servisinde COVID-19 tanısı ile takip edilen 1 ay ile 18 yaş arası çocuk hastaların serum D vitamini düzeylerini ve kontrol grubu olarak ta poliklinik kontrolüne gelen sağlıklı çocukların serum D vitamini düzeylerini karşılaştırdık. Bulgular: COVID Çocuk Yoğun Bakım Ünitesi’ nde yatan 15 çocuk hasta ve COVID çocuk hastalıkları servisinde yatan 25 çocuk hasta çalışmaya dahil edildi. Sağlıklı kontrol grubunda 40 çocuk çalışmaya dahil edildi. Hasta grupları arasında cinsiyet ve yaş açısından fark yoktu (p>0,05). Çocuk yoğun bakım ünitesinde yatan hastaların 25-OH D vitamini düzeyi; çocuk hastalıkları servisinde yatan hastaların 25-OH D vitamini düzeyinden anlamlı olarak düşük bulundu (median (min-max) 11,69 (3-27) ng/mL ve 20,8 (6,3-36,8) ng/mL idi (p=0,005). Sonuç: Çalışmamızda D vitamini eksikliğinin COVID-19 u ciddi olarak geçirme açısından bir risk faktörü olabileceğini gösterdik. D vitamini desteği, bağışıklık sistemini ve enfeksiyona cevabı dengeleyerek ağır klinik düzeyde geçirilen COVID-19 hastalığının tedavisinde yardımcı olabilir.

Keywords

• Çocuk
• COVİD-19
• pandemi
• vitamin D

References

1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.
2. Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta bio-medica: Atenei Parmensis. 2020;91(1):157.
3. Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.
4. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J et al. SARS-CoV-2 Infection in Children. N Engl J Med. 2020;382(17):1663-5.
5. Urry Z, Chambers ES, Xystrakis E, Dimeloe S, Richards DF, Gabryšová L et al. The role of 1α,25-dihydroxyvitamin D3 and cytokines in the promotion of distinct Foxp3+ and IL-10+ CD4+ T cells. Eur J Immunol. 2012;42(10):2697-708.
6. Clark A, and Mach N. Role of Vitamin D in the Hygiene Hypothesis: The Interplay between Vitamin D, Vitamin D Receptors, Gut Microbiota, and Immune Response. Front Immunol. 2016;7:627.
7. Black PN, Scragg R, Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey. Chest. 2005;128(6):3792-8.
8. Talebi F, Nejad MR, Yaseri M, Hadadi Al. Association of Vitamin D Status with the Severity and Mortality of Community-Acquired Pneumonia in Iran during 2016-2017: A Prospective Cohort Study. Rep Biochem Mol Biol. 2019;8(1):85-90.

9. Laaksi I, Ruohola JP, Mattila V, Auvinen A, Ylikomi T, Pihlajamäki H. Vitamin D supplementation for the prevention of acute respiratory tract infection: a randomized, double-blinded trial among young Finnish men. J Infect Dis. 2010;202(5):809-14.
10. Hollis BW, Wagner CL, Normal serum vitamin D levels. N Engl J Med. 2005;352(5):515-6.
11. Sahin ON, Serdar M, Serteser M, Unsal I, Ozpinar A, et al. Vitamin D levels and parathyroid hormone variations of children living in a subtropical climate: a data mining study. Ital J Pediatr. 2018;44(1):40.
12. Mauro Panteghini RB. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Elsevier. 2018
13. Shen K, Yang Y, Wang T, Zhao D, Jiang Y, Jin R et al. Diagnosis, treatment, and prevention of 2019 novel coronavirus infection in children: experts' consensus statement. World J Pediatr. 2020;16(3):223-31.
14. Ye K, Tang F, Liao X, Shaw BA, Deng M, Huang G et al. Does Serum Vitamin D Level Affect COVID-19 Infection and Its Severity?-A Case-Control Study. J Am Coll Nutr. 2021;40(8):724-31
15. Yılmaz K, Şen V. Is vitamin D deficiency a risk factor for COVID-19 in children? Pediatr Pulmonol. 2020;55(12):3595-601.
16. Alpcan A, Tursun S, Kandur Y. Vitamin D levels in children with COVID-19: a report from Turkey. Epidemiol Infect. 2021;149:e180
17. Zhao M. Cytokine storm and immunomodulatory therapy in COVID-19: Role of chloroquine and anti-IL-6 monoclonal antibodies. Int J Antimicrob Agents, 2020;55(6):105982.
18. Lynch KL, Whitman JD, Lacanienta NP, Beckerdite EW, Kastner SA, Shy BR et al. Magnitude and kinetics of anti-SARS-CoV-2 antibody responses and their relationship to disease severity. Clin Infect Dis. 2021;72(2):301-8.
19. Liu NQ, Hewison M, Vitamin D, the placenta and pregnancy. Arch Biochem Biophys. 2012;523(1):37-47.
20. Gubatan J, Mitsuhashi S, Longhi MS, Zenlea T, Rosenberg L, Robson S et al. Higher serum vitamin D levels are associated with protective serum cytokine profiles in patients with ulcerative colitis. Cytokine. 2018;103:38-45.
21. Telcian AG, Zdrenghea MT, Edwards MR, Laza-Stanca V, Mallia P, Johnston SL et al. Vitamin D increases the antiviral activity of bronchial epithelial cells in vitro. Antiviral Res. 2017;137:93-101.
22. Gubatan J, Mehigan GA, Villegas F, Mitsuhashi S, Longhi MS, Malvar G, Csizmadia E et al. Cathelicidin Mediates a Protective Role of Vitamin D in Ulcerative Colitis and Human Colonic Epithelial Cells. Inflamm Bowel Dis. 2020;26(6):885-97.
23. Bock G, Prietl B, Mader JK, Höller E, Wolf M, Pilz S et al. The effect of vitamin D supplementation on peripheral regulatory T cells and β cell function in healthy humans: a randomized controlled trial. Diabetes Metab Res Rev. 2011;27(8):942-5.
24. Aygun H. Vitamin D can prevent COVID-19 infection-induced multiple organ damage. Naunyn Schmiedebergs Arch Pharmacol. 2020;393(7):1157-160.
25. Saggese G, Vierucci F, Prodam F, Cardinale F, Cetin I, Chiappini E et al., Vitamin D in pediatric age: consensus of the Italian Pediatric Society and the Italian Society of Preventive and Social Pediatrics, jointly with the Italian Federation of Pediatricians. Ital J Pediatr. 2018;44(1):51.