Covid-19 hastalarında serum 25-OH vitamin D3 düzeyleri ve hastalık aktivitesine etkileri: Prospektif kesitsel bir çalışma

Amaç: Çalışmamızda, Koronavirüs Hastalığı-19 (Covid-19) hastalarında D vitamini düzeyleri ile hastalık şiddeti, prognoz ve inflamasyon belirteçleri arasındaki ilişkiyi belirlemeyi amaçladık. Gereç ve Yöntem: Hastanemizde Covid-19 tanısı ile yatırılan 100 hastanın serum 25-hidroksi vitamin D düzeyleri ile C-Reaktif Protein (CRP), D-Dimer, prokalsitonin, fibrinojen, ferritin düzeyleri ve Postero-anterior Akciğer grafisi ve Akciğer Bilgisayarlı Tomografi görüntüleri değerlendirildi. Bulgular: D vitamini eksikliği ve yetersizliği olan hastaların D-Dimer düzeyleri ve CRP düzeyleri anlamlı derecede yüksekti (p<0,05). D vitamini düzeyleri ile akciğer tutulum oranı, yoğun bakım ihtiyacı, mortalite ve hastanede kalış süresi arasında anlamlı bir ilişki yoktu. Sonuç: Covid-19’da, D vitamini düzeylerinin etkisine ilişkin belirsizlikler devam etmektedir ve daha fazla sayıda hastayı içeren, komorbiditeleri dışlayan, D vitamini tedavisini değerlendiren çok merkezli randomize kontrollü çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler:

Covid-19, D vitamini eksikliği, Hastalık şiddeti, Mortalite

Serum 25-OH vitamin D3 levels and effects on disease activity in Covid-19 patients: A prospective cross-sectional study

Aim: In our study, we aimed to determine the relationship between vitamin D levels and disease severity, prognosis and inflammation markers in Coronavirus Disease-19 (Covid-19). Materials and Methods: Serum 25-hydroxy vitamin D, C-Reactive Protein (CRP), D-Dimer, procalcitonin, fibrinogen, ferritin levels and Postero-anterior Chest X-ray and Lung Computerized Tomography images of 100 patients hospitalized with the diagnosis of Covid-19 in our hospital were evaluated. Results: D-Dimer and CRP levels of patients with vitamin D deficiency and insufficiency were significantly higher (p<0.05). There was no significant relationship between vitamin D levels and lung involvement rate, need for intensive care, mortality and length hospital stay. Conclusion: Uncertainties regarding the effect of vitamin D levels in Covid-19 remain, and there is a need for multicenter randomized controlled studies that include a larger number of patients, exclude comorbidities, and evaluate vitamin D therapy.

Keywords:

Covid-19, Disease severity, Mortality, Vitamin D deficiency,

PDF

___

Kakodkar P, Kaka N, Baig MN. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19). Cureus. 2020;12(4):e7560.
Fu L, Wang B, Yuan T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020;80(6):656-65.
Jin JM, Bai P, He W, et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front Public Health. 2020;8:152.
Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? BMJ. 2020;369:m1548.
Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153-65.
Chalmers JD, McHugh BJ, Docherty C, Govan JRW, Hill AT. Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis. Thorax. 2013;68(1):39-47.
Mamani M, Muceli N, Ghasemi Basir HR, Vasheghani M, Poorolajal J. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study. Int J Gen Med. 2017;10:423-9.
Dancer RC, Parekh D, Lax S, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax. 2015;70(7):617-24.
Gruber-Bzura BM. Vitamin D and Influenza-Prevention or Therapy? Int J Mol Sci. 2018;19(8):2419.
Berry DJ, Hesketh K, Power C, Hyppönen E. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr. 2011;106(9):1433-40.
Fletcher RH, Fairfield KM. Vitamins for chronic disease prevention in adults: clinical applications. JAMA. 2002;287(23):3127-9.
Holick MF. The vitamin D epidemic and its health consequences. J Nutr. 2005;135(11):2739-48.
Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D. Ross AC, Taylor CL, Yaktine AL, Del Valle HB, editors. Washington (DC): National Academies Press (US); 2011.
Dusso AS, Brown AJ, Slatopolsky E. Vitamin D. Am J Physiol Renal Physiol. 2005;289(1):8-28.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911-30.
Hill TR, Granic A, Davies K, et al. Serum 25-hydroxyvitamin D concentration and its determinants in the very old: the Newcastle 85+ Study. Osteoporos Int. 2016;27(3):1199-208.
Pereira-Santos M, Costa PRF, Assis AMO, Santos CAST, Santos DB. Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obes Rev. 2015;16(4):341-9.
Rhodes JM, Subramanian S, Laird E, Kenny RA. Editorial: low population mortality from COVID-19 in countries south of latitude 35 degrees North supports vitamin D as a factor determining severity. Aliment Pharmacol Ther. 2020;51(12):1434-7.
Kara M, Ekiz T, Ricci V, Kara Ö, Chang KV, Özçakar L. 'Scientific Strabismus' or two related pandemics: coronavirus disease and vitamin D deficiency. Br J Nutr. 2020;124(7):736-41.
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. 2021;44(4):765-71.
Panagiotou G, Tee SA, Ihsan Y, et al. Low serum 25-hydroxyvitamin D (25 [OH] D) levels in patients hospitalised with COVID-19 are associated with greater disease severity: Results of a local audit of practice. MedRxiv 2020.
Baktash V, Hosack T, Patel N, et al. Vitamin D status and outcomes for hospitalised older patients with COVID-19. Postgrad Med J. 2021;97(1149):442-7.
Radujkovic A, Hippchen T, Tiwari-Heckler S, Dreher S, Boxberger M, Merle U. Vitamin D deficiency and outcome of COVID-19 patients. Nutrients. 2020;12(9):2757.
Kaufman HW, Niles JK, Kroll MH, Bi C, Holick MF. SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels. PLoS One. 2020;15(9):e0239252.
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.
Kohlmeier M. Avoidance of vitamin D deficiency to slow the COVID-19 pandemic. BMJ Nutr Prev Health. 2020;3(1):67-73.
Public Health England. Beyond the data: Understanding the impact of COVID-19 on BAME groups. PHE. 2020
Rhodes JM, Subramanian S, Laird E, Griffin G, Kenny RA. Perspective: Vitamin D deficiency and COVID-19 severity-plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis. J Intern Med. 2021;289(1):97-115.
Durmaz A. The Relationship Between COVID-19 Infection and Vitamin D Levels. BAUN Health Sci J. 2022;11(1):103-8.
Okan F, Okan S, Hanoğlu Y. Is Vitamin D Level Associated with COVID-19 Infection?. Med J West Black Sea. 2022;6(1):48-52.
Grant WB, Lahore H, McDonnell SL, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020;12(4):988.
Bourgonje AR, Abdulle AE, Timens W, et al. Angiotensin‐converting enzyme 2 (ACE2), SARS‐CoV‐2 and the pathophysiology of coronavirus disease 2019 (COVID‐19). J Pathol. 2020;251(3):228-48.
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):2116-25.
McElvaney OJ, McEvoy NL, McElvaney OF, et al. Characterization of the Inflammatory Response to Severe COVID-19 Illness. Am J Respir Crit Care Med. 2020;202(6):812-21.
Cutolo M, Paolino S, Smith V. Evidences for a protective role of vitamin D in COVID-19. RMD Open. 2020;6(3):e001454.
Annweiler G, Corvaisier M, Gautier J, et al. Vitamin D supplementation associated to better survival in hospitalized frail elderly COVID-19 patients: the GERIA-COVID quasi-experimental study. Nutrients. 2020;12(11):3377.
Cereda E, Bogliolo L, Lobascio F, et al. Vitamin D supplementation and outcomes in coronavirus disease 2019 (COVID-19) patients from the outbreak area of Lombardy, Italy. Nutrition. 2021;82:111055.
Castillo ME, Costa LME, Barrios JMV, et al. Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study. J Steroid Biochem Mol Biol. 2020;203:105751.
Ling SF, Broad E, Murphy R, et al. High-dose cholecalciferol booster therapy is associated with a reduced risk of mortality in patients with COVID-19: a cross-sectional multi-centre observational study. Nutrients. 2020;12(12):3799.
Murai IH, Fernandes AL, Sales LP, et al. Effect of a single high dose of vitamin D3 on hospital length of stay in patients with moderate to severe COVID-19: a randomized clinical trial. JAMA. 2021;325(11):1053-60.
Kerget B, Kerget F, Kızıltunç A, et al. Evaluation of the relationship of serum vitamin D levels in COVID-19 patients with clinical course and prognosis. Tuberk Toraks. 2020;68(3):227-35.
Güvenç D, Atilla A, Avcı B, et al. Does the plasma vitamin D level affect the severity of infection in COVID-19 patients of different age groups?. Med J Pamukkale. 2022;15(3):499-512.
Coster D, Wasserman A, Fisher E, et al. Using the kinetics of C-reactive protein response to improve the differential diagnosis between acute bacterial and viral infections. Infection. 2020;48(2):241-8.
Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem. 2004;279(47):48487-90.
Wang G, Wu C, Zhang Q, et al. C-reactive protein level may predict the risk of COVID-19 aggravation. Open Forum Infect Dis. 2020;7(5):ofaa153.
Alarslan P, Celiker E, Arslan Z, Kocabas GU, Ozyurtkan O. Vitamin D Levels and Disease Severity in Covid-19. Med J Izmir Hospital. 2022;26(3):311-8.
Karonova TL, Andreeva AT, Golovatuk KA, et al. Low 25 (OH) D Level Is Associated with Severe Course and Poor Prognosis in COVID-19. Nutrients. 2021;13(9):3021.
Bassatne A, Basbous M, Chakhtoura M, El Zein O, Rahme M, Fuleihan GEH. The link between COVID-19 and VItamin D (VIVID): a systematic review and meta-analysis. Metabolism. 2021;119:154753.
Crafa A, Cannarella R, Condorelli RA, et al. Influence of 25-hydroxy-cholecalciferol levels on SARS-CoV-2 infection and COVID-19 severity: A systematic review and meta-analysis. EClinicalMedicine. 2021;37:100967.
Karcıoğlu L, Çöklü ZH. Avrupa ülkelerinin D vitamini ortalama düzeyleri ile COVID-19 vaka ve mortalite oranları arasındaki ilişki. Anadolu Kliniği Tıp Bilimleri Dergisi. 2022;27(2):127-34.