Prevalence of hypovitaminosis D in COVID-19 patients in the intensive care unit
- Authors: Bychinin M.V.1, Mandel’ I.A.1, Klypa T.V.1,2, Kolyshkina N.A.1, Andreichenko S.A.1
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Affiliations:
- Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
- Issue: Vol 12, No 1 (2021)
- Pages: 25-32
- Section: Original Study Articles
- URL: https://journals.rcsi.science/clinpractice/article/view/64976
- DOI: https://doi.org/10.17816/clinpract64976
- ID: 64976
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Abstract
Background: The prevalence of hypovitaminosis D has not been studied in the Russian Federation for the group of patients with severe and extremely severe COVID-19 in the intensive care unit (ICU). Aims: To study the prevalence of hypovitaminosis D in patients with COVID-19 treated in the ICU and to determine the relationship between the vitamin D status and disease outcome. Methods: The retrospective study included 103 adult patients with severe and extremely severe COVID-19 hospitalized in the ICU. Results: 94% patients (n = 97) showed a significant decrease in the concentration of 25 (OH) D in their blood serum — 11 ng/ml [7; 15 ng/ml]. 37% (n = 38) of patients showed vitamin D deficiency, 46% (n = 47) had severe vitamin D deficiency, 12% (n = 12) had vitamin D insufficiency, 5% (n = 6) had normal vitamin D levels. In the group of patients with vitamin D levels less than 10 ng/ml, the mortality rate was significantly higher than that in the group of patients with the levels of vitamin D exceeding 10 ng/ml (66% and 42%, p = 0.018). These two groups of patients also significantly differed in their age (p = 0.018), history of diabetes mellitus (p = 0.059), white blood cell count (p = 0.045), neutrophil to lymphocyte ratio (p = 0.017), D-dimer level (p = 0.05) and troponin T level (p = 0.054). Conclusion: A high incidence of vitamin D insufficiency in patients with COVID-19 treated in the ICU has been identified. Severe vitamin D deficiency was more often found in elderly patients with diabetes mellitus, and was associated with the increased mortality. The identified relationship of the vitamin D deficiency with the neutrophilic-lymphocytic index suggests an immuno-mediated effect on the outcome of patients with COVID-19.
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##article.viewOnOriginalSite##About the authors
Mikhail V. Bychinin
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Author for correspondence.
Email: drbychinin@gmail.com
ORCID iD: 0000-0001-8461-4867
SPIN-code: 6524-9947
Cand. Sci. (Med.)
Russian Federation, 28, Orechovy boulevard, Moscow 115682Irina A. Mandel’
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: irina.a.mandel@gmail.com
ORCID iD: 0000-0001-9437-6591
SPIN-code: 7778-2184
Cand. Sci. (Med.)
Russian Federation, 28, Orechovy boulevard, Moscow 115682Tatiana V. Klypa
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency; I.M. Sechenov First Moscow State Medical University (Sechenov University)
Email: tvklypa@gmail.com
ORCID iD: 0000-0002-2732-967X
Dr. Sci. (Med.)
Russian Federation, 28, Orechovy boulevard, Moscow 115682; MoscowNadezhda A. Kolyshkina
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: baklab_83@mail.ru
ORCID iD: 0000-0003-4486-5412
MD
Russian Federation, 28, Orechovy boulevard, Moscow 115682Sergei A. Andreichenko
Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency
Email: sergandletter@gmail.com
ORCID iD: 0000-0002-3180-3805
SPIN-code: 3186-2493
MD
Russian Federation, 28, Orechovy boulevard, Moscow 115682References
- Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi: 10.1056/NEJMoa2002032
- Panarese A, Shahini E. Letter: Covid-19, and vitamin D. Alimentary Pharmacology & Therapeutics. 2020;9:1–3. doi: 10.1111/apt.15752
- Moromizato T, Litonjua AA, Braun AB, et al. Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill. Crit Care Med. 2014;42(1):97–107. doi: 10.1097/CCM.0b013e31829eb7af
- Quraishi SA, Bittner EA, Blum L, et al. Prospective study of vitamin D status at initiation of care in critically ill surgical patients and risk of 90-day mortality. Crit Care Med. 2014;42(6):1365–1371. doi: 10.1097/CCM.0000000000000210
- Braun A, Chang D, Mahadevappa K, et al. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med. 2011;39(4):671–677. doi: 10.1097/CCM.0b013e318206ccdf
- D’Avolio A, Avataneo V, Manca A, et al. 25-Hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2. Nutrients. 2020;12(5):1359.
- Carpagnano GE, Di Lecce V, Quaranta VN, et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J Endocrinol Invest. 2020. doi: 10.1007/s40618-020-01370-x
- Panagiotou G, Tee SA, Ihsan Y, et al. Original publication: low serum 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalized with COVID-19 are associated with greater disease severity. Clin Endocrinol (Oxf). 2020;93(5):629–630. doi: 10.1111/cen.14310
- Каронова Т.Л., Андреева А.Т., Вашукова М.А. Уровень 25(ОН)D в сыворотке крови у больных COVID-19 // Журнал инфектологии. 2020. Т. 12, № 3. С. 21–27. [Karonova TL, Andreeva АТ, Vashukova МА. Serum 25(oH)D level in patients with CoVID-19. J Infectology. 2020;12(3):21–27. (In Russ).] doi: 10.22625/2072-6732-2020-12-3-21-27
- WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected [accessed Feb 8, 2020]. 2020. Avalable from: https://www.who.int/publications-detail/clinical-management-ofsevere-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
- Lips P, Cashman KD, Lamberg-Allardt C, et al. Current vitamin D status in European and Middle East countries and strategies to prevent vitamin D deficiency: a position statement of the European Calcified Tissue Society. Eur J Endocrinol. 2019;180(4):P23–P54. doi: 10.1530/EJE-18-0736
- Jain A, Chaurasia R, Sengar NS, et al. Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. Sci Rep. 2020;10(1):20191. doi: 10.1038/s41598-020-77093-z
- Orchard L, Baldry M, Nasim-Mohi M, et al. Vitamin D levels and intensive care unit outcomes of a cohort of critically ill COVID-19 patients [published online ahead of print, 2021 Jan 18]. Clin Chem Lab Med. 2021;10.1515/cclm-2020-1567. doi: 10.1515/cclm-2020-1567
- Vassiliou AG, Jahaj E, Pratikaki M, et al. Low 25-Hydroxyvitamin D levels on admission to the intensive care unit may predispose COVID-19 pneumonia patients to a higher 28-day mortality risk: a pilot study on a greek ICU cohort. Nutrients. 2020;12(12):3773. doi: 10.3390/nu12123773
- Czarnik T, Czarnik A, Gawda R, et al. Vitamin D kinetics in the acute phase of critical illness: a prospective 349 observational study. J Crit Care. 2018;43:294–299. doi: 10.1016/j.jcrc.2017.09.179. 350
- Nair P, Lee P, Reynolds C, et al. Significant 351 perturbation of vitamin D-parathyroid-calcium axis and adverse clinical outcomes in critically ill 352 patients. Int Care Med. 2013;39(2):267–274. doi: 10.1007/s00134-012-2713-y
- Gallagher JC. Vitamin D and aging. Endocrinol Metab Clin North Am. 2013;42(2):319–332. doi: 10.1016/j.ecl.2013.02.004
- Khare D, Godbole NM, Pawar SD, et al. Calcitriol [1,25[OH]2D3] pre- and post-treatment suppresses inflammatory response to influenza A(H1N1) infection in human lung A549 epithelial cells. Eur J Nutr. 2013;52(4):1405–1415. doi: 10.1007/s00394-012-0449-7
- Parlak E, Ertürk A, Çağ Y, et al. The effect of inflammatory cytokines and the level of vitamin D on prognosis in Crimean-Congo hemorrhagic fever. Int J Clin Exp Med. 2015;8(10):18302–18310.
- Silberstein M. Vitamin D: A simpler alternative to tocilizumab for trial in COVID-19? Med Hypotheses. 2020;140:109767. doi: 10.1016/j.mehy.2020.109767
- Kong J, Zhu X, Shi Y, et al. VDR attenuates acute lung injury by blocking Ang-2-Tie-2 pathway and renin-angiotensin system. Mol Endocrinol. 2013;27(12):2116–2125. doi: 10.1210/me.2013-1146
- Xu J, Yang J, Chen J, et al. Vitamin D alleviates lipopolysaccharide-induced acute lung injury via regulation of the renin-angiotensin system. Mol Med Rep. 2017;16(5):7432–7438. doi: 10.3892/mmr.2017.7546
- Li B, Baylink DJ, Walter MH, et al. Targeted 25-hydroxyvitamin D3 1α-hydroxylase adoptive gene therapy ameliorates dss-induced colitis without causing hypercalcemia in mice. Mol Ther. 2015;23(2):339–351. doi: 10.1038/mt.2014.201
- Zhao H, Zhang H, Wu H, et al. Protective role of 1,25(OH)2 vitamin D3 in the mucosal injury and epithelial barrier disruption in DSS-induced acute colitis in mice. BMC Gastroenterol. 2012;12:57. doi: 10.1186/1471-230X-12-57
- Herr C, Shaykhiev R, Bals R. The role of cathelicidin and defensins in pulmonary inflammatory diseases. Expert Opin Biol Ther. 2007;7(9):1449–1461. doi: 10.1517/14712598.7.9.1449
- Hahn S, Haselhorst U, Tan S, et al. Low serum 25-hydroxyvitamin D concentrations are associated with insulin resistance and obesity in women with polycystic ovary syndrome. Exp Clin Endocrinol Diabetes. 2006;114(10):577–583. doi: 10.1055/s-2006-948308
- Baynes KC, Boucher BJ, Feskens EJ, Kromhout D. Vitamin D, glucose tolerance and insulinaemia in elderly men. Diabetologia. 1997;40(3):344–347. doi: 10.1007/s001250050685
- Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5
- Клыпа Т.В., Бычинин М.В., Мандель И.А., и др. Клиническая характеристика пациентов с COVID-19, поступающих в отделение интенсивной терапии. Предикторы тяжелого течения // Клиническая практика. 2020. Т. 11, № 2. С. 6–20. [Klypa TV, Bychinin MV, Mandel IA, et al. Clinical characteristics of patients admitted to an ICU with COVID-19. predictors of the severe disease. Journal of Clinical Practice. 2020;11(2):6–20. (In Russ).] doi: 10.17816/clinpract34182