Does Vitamin D Supplementation Reduce Cytokine Storm and Mortality in Geriatric Intensive Care Patients Diagnosed with COVID-19

Öz

Introduction: Coronavirus disease progresses from an asymptomatic stage to a fatal stage characterized by a cytokine storm. Therefore, treatment should focus on enhancing the patients’immune function and preventing cytokine release syndrome. Vitamin-D deficiency is one of the factors triggering cytokine release syndrome. The present study aimed to emphasize the therapeutic effect of vitamin-D supplementation and its potential importance in reducing the disease severity in older adults in the intensive care unit after COVID-19 diagnosis. Materials and Method: The data of 80 patients aged ≥ 65 years who followed up in intensive care clinic. The inflammatory parameters and clinical course of 40 patients whose serum 25-hydroxyvitamin-D level was below 30ng/ml and who received vitamin-D supplementation (case-group) were recorded on the fifth and tenth days of follow-upand compared with those of the other 40 patients who were hospitalized during the initial period of the pandemic and who did not receive vitamin-D supplementation (control-group). Results: Cytokine release syndrome, has developed in the case group rarely. On the 10.day, levels of the inflammatory markers C-reactive protein, procalcitonin, D-dimer, ferritin, interleukin-6, and lactate dehydrogenase were significantly lower and the lymphocyte count was significantly higher in the case group than in the control group. On the 5.day, the interleukin-6 level was significantly lower in the case group. Weaning was performed in nine and four patients in the case and control groups, respectively. There was no significant difference in mortality rates between the groups. Conclusion: Vitamin-D supplementation can help reduce cytokine response. Recommended prophylactically or therapeutically at all stages of coronavirus disease.

Anahtar Kelimeler

• ELDERLY PATIENTS
• COVID-19
• Cytokine Release Syndrome
• IntensiveCareUnits
• Vitamin D

Covıd-19 tanılı Geriatrik Yoğun Bakım Hastalarında D Vitamini Desteği Sitokin Fırtınasını ve Mortaliteyi Azaltır mı?

Öz

Amaç: COVID-19 enfeksiyonunda klinik; asemptomatik durumdan, sitokin fırtınası ile karakterize ölümcül tabloya kadar değişen geniş bir yelpazede seyretmektedir. Bu nedenle tedaviler hastaların bağışıklık fonksiyonunun arttırılmasına ve sitokin fırtınasının engellenmesine odaklanmalıdır. D vitamini eksikliği, şiddetin belirleyicilerinden biri olarak kabul edilmiştir. Bu makalede, tanı aldıktan sonra yoğun bakımda takibe başlanan geriatrik hasta grubunda D vitamini desteğinin terapötik etkisi ve hastalık şiddeti üzerine potansiyel önemini vurgulamak istiyoruz. Materyal ve Metod: Mart ve Haziran 2021 tarihleri arasında Yoğun Bakım Kliniğimizde takip edilen COVID-19 tanısı almış 65 yaş ve üstü 80 hastanın verileri retrospektif olarak incelendi. Serum 25 (OH) D<30ng / mL olan ve Dvitamini desteği başlanan 40 hastanın, COVID-19 tanısı aldıktan sonra 5. ve 10. günlerdeki enflamatuar parametreleri ve klinik seyri kaydedilerek, D vitamini desteği başlanmamış olan kontrol grubunun verileri ile karşılaştırıldı. Bulgular: 80 hastadan40’ı (%50) erkek ve 40’ı (% 50) kadın idi. Hastaların ortalama yaşı 72 ± 10.8 yıldı.10. gün ölçümlerinde enflamatuar belirteçlerden CRP, Prokalsitonin, D-Dimer, Ferritin, IL-6, LDH değerlerinin kontrol grubuna göre anlamlı düşük seyrettiği (P<0.05) ve lenfosit değerininanlamlı yüksek seyrettiği gözlendi (p=0.008) (Tablo 2).Beşinci gün ölçümlerinde IL-6 düzeyi vaka grubunda anlamlı olarak daha düşüktü. Vaka ve kontrol grubunda sırasıyla 9 ve 4 hastada weaning uygulandı. Gruplar arasında weaning ve mortalite oranları açısından istatistiklsel olarak anlamlı bir fark görülmedi. Sonuç:D vitamini tedavisinin, özellikle hipovitaminoz D'nin sık görüldüğü geriatrik hastalarda hastalık şiddetini ve sitokin yanıtını azaltmada katkı sağlayabileceği makul görünmektedir. D vitamini takviyesi, coronavirüs hastalığının tüm aşamalarında profilaktik veya terapötik olarak önerilir.

Anahtar Kelimeler

• Geriatrik Popülasyon
• COVID-19
• Sitokin Fırtınası
• Yoğun Bakım Üniteleri
• D Vitamini

Kaynakça

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