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Impact of Vitamin D Deficiency on COVID-19 – A Prospective Analysis from the CovILD Registry

Take Home Message

In this study, Vitamin D deficiency is frequent among COVID-19 patients, but not associated with disease outcomes. However, individuals with severe disease display a disturbed parathyroid-vitamin-D axis within their recovery phase. This may lead to elevated calcium in the blood which long term can increase risk of fractures but it is not known if this elevation is just from the hospitalization or will be long term.

Results

  • A high proportion of patients presented with impaired VITD metabolism and elevated parathyroid hormone (PTH) levels.
  • PTH concentrations were increased in patients who needed intensive care unit (ICU) treatment.
  • VITD levels were not significantly different between disease severity groups.
  • Low VITD levels at disease onset or at eight-week follow-up were not related to persistent symptom burden, lung function impairment, ongoing inflammation, or more severe CT abnormalities.
  • VITD deficiency is frequent among COVID-19 patients, but not associated with disease outcomes. However, individuals with severe disease display a disturbed parathyroid-vitamin-D axis within their recovery phase.

Who

109 Hospitalized and outpatient subjects were included in the analysis (60% males, 40% females), aged 58 ± 14 years in Austria.

Things to Keep in Mind

  • There are many related issues that could have influenced the results therefore it is hard to dismiss a relationship between vitamin D and COVID-19 but it is certainly not confirmed with this data.
  • The PTH involvement is interesting and requires further investigation

Author’s Conclusions

In this study, 25(OH)D concentrations do not associate with persistent inflammation, impairment in pulmonary function tests, pathological findings in CT-scans, or the persistence of symptoms. However, individuals with severe disease display a disturbed parathyroid-vitamin-D axis within their recovery phase, most likely due to prolonged hospitalization, although the question about causality or consequence cannot be answered through our data, and more evidence from interventional RCTs is warranted to properly understand the role of VITD in COVID-19. Conclusively, the proposed significance of VITD in the clinical management of COVID-19 remains elusive.

Study Design

  • Results are from an ongoing prospective, multicenter, observational study on long-term connected diseases and includes patients with COVID-19 after hospitalization or outpatients with persistent symptoms.
  • Eight weeks after PCR confirmed diagnosis of COVID-19, a detailed questionnaire, a clinical examination, and laboratory testing, including Vitamin D (VITD) status, were evaluated.
  • Available laboratory specimens close to hospital admission were used to retrospectively analyze 25-hydroxyvitamin D levels at disease onset.
  • VITD deficiency was defined as 25(OH)D levels below 30 nmol/L. Serum concentrations of 25(OH)D between 30 and 50 nmol/L were categorized as insufficient VITD supply, whereas 25(OH)D above 100 nmol/L were considered normal.
  • Disease severity was categorized as mild for patients in outward treatment; moderate for patients in inward treatment; and severe for patients requiring oxygen supply, respiratory support, or intensive care treatment.

Reference

Pizzini A, Aichner M, Sahanic S, Böhm A, Egger A, Hoermann G, Kurz K, Widmann G, Bellmann-Weiler R, Weiss G, Tancevski I, Sonnweber T, Löffler-Ragg J. Impact of Vitamin D Deficiency on COVID-19-A Prospective Analysis from the CovILD Registry. Nutrients. 2020 Sep 11;12(9):2775. doi: 10.3390/nu12092775. PMID: 32932831; PMCID: PMC7551662.

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The Biochemical Parameters and Vitamin D Levels in ICU Patients with Covid-19: A Cross-Sectional Study. Take Home Message In a cross-sectional study of 118 COVID-19 patients in Iran who required ICU

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