Vitamin D Levels and its Association with Inflammatory Markers, Severity and Outcome in Hospitalised COVID-19 Patients - An Indian Perspective
Abstract
Background: The recent COVID-19 pandemic has taken over the world in enormous proportions like none other in recent times. Vitamin D plays an essential role in the immune system and has proven to have importance in the context of many respiratory infections. This study aims to unveil the possible correlation between vitamin D levels and disease outcome and affirm the role of hypovitaminosis D as an independent risk factor for severity in COVID 19.
Methods: We studied 209 RTPCR confirmed COVID 19 positive cases. Serum 25(OH) D levels were done at the time of admission. HRCT chest and inflammatory markers (serum ferritin, D dimer, IL6 and CRP) were estimated on admission and repeated on case-to-case basis.
Results: Out of 209 patients studied, 44.49% had vitamin D deficiency, 24.40% had Vitamin D insufficiency, and 31.11% had normal Vitamin D levels. Vitamin D deficiency significantly increased with advancing age. The mean vitamin D level in our study is 27.47 ± 21.86. 27.8% had mild COVID-19 disease as evidenced by HRCT imaging, 21.1% showed moderate disease, and 51.2% showed severe COVID-19. The mean values of inflammatory markers in Vitamin D deficient patients were as follows: D dimer (3298.88 ± 2230.14), Serum Ferritin (530.88 ± 497.14) CRP (175.34 ± 87.27) IL6 (125.39 ± 275.72). Significant correlation of Vitamin D with C reactive protein (r = -0.18, p ≤ 0.05), D-Dimer (r = -0.42, p < 0.0001), and CT severity score (r = -0.24, p ≤ 0.0001) was noted.
Conclusion: In our study, Vitamin D inversely proportional levels were inversely proportional to CRP, D-Dimer, and CT severity.
How to cite this article:
Pande R, Mayilananthi K, Vrinda V, Nainar RY, Bharanidharan G, Ragalikhith K, Krishnan D. Vitamin D Levels and its Association with Inflammatory Markers, Severity and Outcome in Hospitalised COVID-19 Patients - An Indian Perspective. Special Issue - COVID-19 & Other Communicable Disease. 2022;171-176.
DOI: https://doi.org/10.24321/0019.5138.202227
References
Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, evaluation, and treatment of Coronavirus (COVID-19).In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan 5. [PubMed] [Google Scholar]
Carr AC. Micronutrient status of COVID-19 patients: a critical consideration. Crit Care. 2020 Jun;24(1):349.[PubMed] [Google Scholar]
Teshome A, Adane A, Girma B, Mekonnen ZA. The impact of vitamin D level on COVID-19 infection: systematic review and meta-analysis. Front Public Health. 2021 Mar;9:624559.[PubMed] [Google Scholar]
https://apps.who.int/iris/rest/bitstreams/1322790/retrieve
https://www.icmr.gov.in/pdf/covid/techdoc/COVID_Clinical_Management_14012022.pdr
Jain A, Chaurasia R, Sengar NS, Singh M, Mahor S, Narain S.Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. Sci Rep. 2020 Nov;10(1):20191.[PubMed] [Google Scholar]
Saeed GA, Gaba W, Shah A, Al Helali AA, Raidullah E, Al Ali AB, Elghazali M, Ahmed DY, Al Kaabi SG, Almazrouei S.Correlation between chest CT severity scores and the clinical parameters of adult patients with COVID-19 Pneumonia. Radiol Res Pract. 2021 Jan;2021:6697677.[PubMed] [Google Scholar]
Carpagnano GE, Di Lecce V, Quaranta VN, Zito A, Buonamico E, Capozza E, Palumbo A, Di Gioia G, Valerio VN, Resta O. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J Endocrinol Invest. 2021 Apr;44(4):765-71.[PubMed] [Google Scholar]
Radujkovic A, Hippchen T, Tiwari-Heckler S, Dreher S, Boxberger M, Merle U. Vitamin D deficiency and outcome of COVID-19 patients. Nutrients. 2020 Sep;12(9):2757. [PubMed] [Google Scholar]
Demir M, Demir F, Aygun H. Vitamin D deficiency is associated with COVIDâ€19 positivity and severity of the disease. J Med Virol. 2021 May;93(5):2992-9.[PubMed] [Google Scholar]
D’Avolio A, Avataneo V, Manca A, Cusato J, De Nicolò A, Lucchini R, Keller F, Cantù M. 25-Hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2. Nutrients. 2020 May;12(5):1359. [PubMed] [Google Scholar]
Munshi R, Hussein MH, Toraih EA, Elshazli RM, Jardak C, Sultana N, Youssef MR, Omar M, Attia AS, Fawzy MS, Killackey M. Vitamin D insufficiency as a potential culprit in critical COVIDâ€19 patients. J Med Virol. 2021 Feb;93(2):733-40. [PubMed] [Google Scholar]
Nimavat N, Singh S, Singh P, Singh SK, Sinha N. Vitamin D deficiency and COVID-19: acase-control study at a tertiary care hospital in India. Ann Med Surg (Lond). 2021 Aug;68:102661.[PubMed] [Google Scholar]
Ye K, Tang F, Liao X, Shaw BA, Deng M, Huang G, Qin Z, Peng X, Xiao H, Chen C, Liu X. Does serum vitamin D level affect COVID-19 infection and its severity?A case-control study. J Am CollNutr. 2021 Nov-Dec;40(8):724-31.[PubMed] [Google Scholar]
Singh S, Nimavat N, Singh AK, Ahmad S, Sinha N. Prevalence of low level of vitamin D among COVID-19 patients and associated risk factors in India-ahospital-based study. Int J Gen Med. 2021 Jun;14:2523-31.[PubMed] [Google Scholar]
Hunter CA, Jones SA. IL-6 as a keystone cytokine in health and disease. Nat Immunol. 2015 May;16(5):448-57. [PubMed] [Google Scholar]
Kishore J, Grimes DS, Anderson DC, Bharti OK, Joseph B, Ghai G, Sahoo M. Recommendations for high vitamin D supplementation to help fight the COVID-19 pandemic and its inclusion in National COVID-19 management guidelines. Epidem Int. 2021;6(2):6-9. [Google Scholar]
Ricci A, Pagliuca A, D’Ascanio M, Innammorato M, De Vitis C, Mancini R, Giovagnoli S, Facchiano F, Sposato B, Anibaldi P, Marcolongo A, De Dominicis C, Laghi A, Muscogiuri E, Sciacchitano S.Circulating Vitamin D levels status and clinical prognostic indices in COVID-19 patients. Respir Res. 2021 Mar;22(1):76. [PubMed] [Google Scholar]
Sunnetcioglu A, Sunnetcioglu M, Gurbuz E, Bedirhanoglu S, Erginoguz A, Celik S. Serum 25(OH)Ddeficiency and high D-dimer levels are associated with COVID-19 pneumonia. Clin Lab. 2021 Jul;67(7). [PubMed] [Google Scholar]
Copyright (c) 2022 Author's
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
