Cholecalciferol as part of complex therapy for acute COVID-19

During the pandemic of new coronavirus infection, the prevalence of moderate to severe vitamin D deficiency remains high, which is a factor worsening the course of COVID-19. According to some studies, cholecalciferol therapy, added to standard COVID-19 ther-apy, is associated with improving the course and prognosis of the disease. Objective. To evaluate the effect of cholecalciferol therapy at a dose of 100,000 IU on clinical and laboratory parameters in patients with moderate to severe COVID-19 admitted to an infectious hospital. Material and methods. An open single-center interventional study included 129 COVID-19 patients who were further randomized into two groups. Group 1 patients (n=65) received a total dose of 100,000 IU of cholecalciferol in addition to the standard COVID-19 therapy. Group 2 patients (n=64) received standard therapy only. Results. On day 9 of hospitalization, group 1 patients (receiving cholecalciferol) showed a 40.7% increase in serum 25(OH)D level, while group 2 patients (without cholecalciferol therapy) showed a negative trend (p<0.001). In addition, group 1 patients showed higher neutrophil and lymphocyte counts (p=0.047;p=0.025), and a lower level of C-reactive protein (p=0.028). A negative association was found between 25(OH)D levels and CRP values and between 25(OH)D levels and the length of hospital stay. Conclusion. Adding cholecalciferol as a bolus dose to standard COVID-19 therapy has a positive effect on the disease's clinical course and inflammatory markers' levels. Copyright © K.A. GOLOVATYUK, T.L. KARONOVA, A.A. MIKHAILOVA, D.I. LAGUTINA, A.T. CHERNIKOVA, E.YU. VASILIEVA, E.V. SHLYAKHTO.

[SARS-CoV-2 morbidity depending on vitamin D status].

BACKGROUND: The association between vitamin D deficiency and the severity of COVID-19 is currently being actively discussed around the world. AIM: The aim of this study was to assess the prevalence of vitamin D insufficiency and deficiency and compare it with the incidence rates of SARS-CoV-2 in eight Federal Districts of the Russian Federation. MATERIALS AND METHODS: We included 304,564 patients (234,716 women; 77,1%) with serum 25(OH)D levels results performed September 2019 through October 2020. RESULTS: Only 112,877 people (37.1%) had a normal serum 25(OH)D level, others had a deficiency. Vitamin D insufficiency and deficiency was presented with the same frequency in women and men, and no differences were found depending on the geographical location and age in subjects from 18 to 74 years old. However, subjects over 75 years more often had vitamin D deficiency, while subjects under 18 years had normal levels in over 50% cases. In addition, 21,506 patients were tested for SARS-CoV-2 by PCR with further comparison of results with serum 25(OH)D level. The SARS-CoV-2 positivity rate was detected in 3,193 subjects, negative in 18,313. There were no differences in the morbidity in a vitamin D deficiency and a normal level. Thus, 14.8% subjects had positive PCR rates among vitamin D deficiency patients (4,978 tests), 14.9% when 25(OD)D level was from 20 to 30 ng/ml (7,542 tests), 15.0% among those who had 25(OH)D 30- 50 ng/ml (6,622 tests), and 13.9% when vitamin D was more than 50 ng/ml (4,612 tests). CONCLUSION: There was no association between the COVID-19 incidence and vitamin D status in different regions of Russia. Although the nutrient deficiency persists in all regions and is most often diagnosed in people over 75 years old.

Hypokalemia and the renin-angiotensin-aldosterone system activity in COVID-19 patients

Background. Hypokalemia is a common electrolyte complication among hospitalized patients with pneumonia caused by a new coronavirus SARS-CoV-2. Hyperactivation of the renin-angiotensin-aldosterone system (RAAS) is suggested as a possible cause of hypokalemia in patients with COVID-19. Objective. To investigate the RAAS activity in COVID-19 patients with and without hypokalemia and its possible association with treatment outcomes. Design and methods. The cross-sectional cohort study included 172 patients with COVID-19 pneumonia. Potassium, aldosterone and venous renin were measured in 77 patients. The differences in the levels of acute phase proteins, the degree of lung damage and the severity of COVID-19 were compared between patients with and without hypokalemia. Results. Hypokalemia was found in 19 of 77 patients (25%): the median potassium level in hypokalemia and eukalemia group was 3,1 [2,8-3,3] and 4,1 [3,9-4,5] mmol/L, respectively (p = 0,001). Plasma aldosterone and renin levels in patients with and without hypokalemia did not differ significantly: aldosterone 76,0 [57,7-121,5] and 70,9 [26,3-113,8] pg/ml (p = 0,23), renin 17,0 [8,5-47,2] and 11,0 [6,5-38,1] pg/ml (p = 0,35), respectively. Differences in the degree of lung tissue damage, acute phase proteins, severity of COVID-19, length of hospitalization and mortality in patients with and without identified electrolyte disturbances were also not significant. Conclusions. Our results showed that there were no laboratory signs of RAAS hyperactivation in COVID-19 patients with registered hypokalemia. Identification of the cause and clinical significance of hypokalemia among patients with COVID-19 needs to be specified. © 2021 All-Russian Public Organization Antihypertensive League. All rights reserved.