ABSTRACT
Introduction: The severity of COVID-19 is determined by the presence of pneumonia, severe ARDS, cytokine storms, and small vessels thrombosis, all involves underlying inflammation. Vitamin D is a fat-soluble vitamin with immuno-modulating and anti-inflammatory properties. The high prevalence of vitamin D deficiency is usually due to inadequate sunlight exposure, sedentary lifestyle, diet poor in vitamin D, and traditional clothing. Vitamin D deficiency is a modifiable risk factor their identification and management can improve outcomes. Materials and methods: This was a prospective observational single centre study of moderatelysevere COVID-19 patients. All consecutive, moderately-severe COVID-19 patients with ICU stay >48 hours were included. Exclusion criteria: consent refusal, pregnant and lactating mothers, Age <18 years, post-cardiac arrest resuscitated patient before ICU admission, patient on multivitamin or Neutraceuticals supplements, chronic diarrhea, and cancer patients. Based on vitamin D levels on ICU admission, patients were stratified into two groups, i.e., ≤20 ng/mL deficient and >20 ng/mL non-deficient group. After demographic data, we collected data of underlying disease;cause of admission;APACHE II on admission and daily SOFA scoring, various morbidities during ICU stay (mechanical ventilation, inotropes/vasopressor, nosocomial infections, etc.), length of ICU stay, ICU mortality and 30 days mortality. Results and discussion: A total of 88 patients were studied, 73 (82.9%) patients had vitamin D deficiency. Median [IQ range] vitamin D levels of the deficient and non-deficient group were 11 [5-17] and 27 [22-35]. Groups did not differ in demographic or clinical characteristics except for age. The elderly age group had a higher prevalence of deficiency and was statistically significant, mean (±SD) age of the deficient vs non-deficient group was 54.78 (±13.30) vs 46.47 (±5.75), p value 0.02. The overall mortality rate of the cohort was 42.05%. Percentage mortality in the deficient group (46.5%) was lower than the non-deficient group (20%) but failed to show statistical significance p value 0.058. In continuous data, deficient group had a poor association with ICU morbidities vs nondeficient group as mean (±SD) duration of mechanical ventilation 4.59 (±2.78) vs 4.07 (±3.21) p value 0.521, and length of ICU stay 8.04 (±2.82) vs 8.53 (±3.04) p value 0.545. In categorical data, deficient group showed increased ICU morbidities vs non-deficient group but were not statistically significant, inotropes/vasopressor requirement 60.3% vs 53.3% p value 0.619, hospital-acquired infection incidence 45.2% vs 40% p value 0.712 and 30 days mortality 75.6% vs 24.4% p value 0.059. In severity scoring, deficient group had higher severity vs non-deficient group but statistical significance was not demonstrated APACHE II 10.74 (±4.42) vs 8.73 (±3.39) p value 0.101 and mean SOFA score 4.17 (±3.33) vs 2.51 (±2.68) p value 0.074. Mean (±SD) levels of vitamin D in survivor vs non-survivors were 11.54 (±5.76) vs 15.45 (±6.92) p value 0.006 showed a correlation between mortality and low vitamin D deficiency levels. However, vitamin D levels failed as an independent risk factor for mortality in multivariate analysis OR (95% C.I.) 1.198 (0.732-1.672), p value 0.296. Conclusion: In moderately-severe COVID-19, vitamin D deficiency was associated with a greater incidence of mortality and morbidity, although the relationship was not statistically significant. Vitamin D deficiency was not found to be an independent risk factor for mortality.