Assessment of Vitamin D Level as a Risk Factor and Illness Severity Indicator in COVID 19 Cases

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-COV2) viruses using angiotensin-converting enzyme 2 (ACE2) receptors, to enter human cells, these receptors are highly expressed in the lung alveolar cells, vascular endothelium, cardiac myocytes, and other cells. Inadequate vitamin D levels in the blood have been linked to a higher risk of COVID-19 severity. Objective: To determine the association between Vitamin D level and severity of COVID-19 infection. Materials and Method: A cross sectional study was conducted at Thumbay Hospital, Ajman, UAE. Enrolled 70 COVID-19 positive hospitalized patients with age group ≥ 18 years old of both genders. Patients taking vitamin D supplements were excluded from the study. The biochemical analysis for the collected blood samples was performed on the automated analyzer and assessed for significance analysis. Result: There is a statistically significant correlation between Vitamin D levels and disease severity (p < 0.05) as determined by Pearson's Chi-square test. Independent t-test shown that there is a statistically significant difference with regards to gender, age groups, and co morbidity (p < 0.05). Pearson's correlation revealed a moderate, positive correlation between Vitamin D levels and the severity of COVID-19 infection, which was statistically significant. Conclusion: Vitamin D levels affect COVID-19 severity, with more severe cases showing vitamin D levels lower than normal when compared to severe cases with sufficient vitamin D levels. Furthermore, blood vitamin D levels are linked to age groups in COVID-19 patients. Vitamin D insufficiency and deficiency, on the other hand, was not linked to a higher risk of death prognosis, and co morbidities. © Sabir SM, Ismail MK, Ibrahim EH, Khan ZA.

The Relationship Between Vitamin D Levels and Severity in Illness in COVID-19 Patients: A Cross-Sectional Study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic hit the world badly with high mortality. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increased the COVID-19 burden among developed and developing countries due to the unavailability of proven treatment options. Vitamin D has many important anti-inflammatory, immunomodulator, and anti-viral functions. The present study was conducted to evaluate the relationship between Vitamin D in COVID-19. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Patna, India. All the patients were enrolled during the period of 3.5 months. A chemiluminescence-based immunoassay analyzer was used to quantify Vitamin D among COVID-19 patients. The study compared Vitamin D deficiency and insufficiency among different groups, i.e., age, sex, BMI, comorbidity, etc. Diabetes and hypertension were evaluated as risk factors for mortality. RESULTS: A total of 225 patients were investigated. Of these, 13.6% had Vitamin D deficiency and 38.9% had insufficiency. Vitamin D level was statistically significant among different age groups, sex, and smokers. Patients aged >60 years were 23 times more likely to have a severe illness (adjusted OR (aOR) 23.53, 95%CI 4.67-118.61), whereas those aged 40 to 60 years were 11 times more likely to have a severe illness (aOR 10.86, 95%CI 2.39-49.31). Patients with many comorbidities, on the other hand, had a tenfold greater chance of severe COVID-19 (aOR 9.94, 95%CI 2.47-39.88). A deficiency of vitamin D increased the chance of a serious illness by nearly five times (aOR 4.72, 95%CI 1.31-17.03). CONCLUSION: Vitamin D level was associated with severity of illness; it can be used to estimate the prognosis of COIVD-19 patients and aid in the modification of treatment protocols.

Habitual use of vitamin D supplements and risk of coronavirus disease 2019 (COVID-19) infection: a prospective study in UK Biobank.

BACKGROUND: Previous studies have related vitamin D supplementation to a lower risk of acute respiratory tract infection. Emerging evidence suggests that vitamin D insufficiency is related to a higher risk of coronavirus disease 2019 (COVID-19) infection. OBJECTIVES: We aimed to investigate the prospective association between habitual use of vitamin D supplements and risk of COVID-19 infection, and assess whether such an association differed according to the different levels of circulating and genetically predicted vitamin D. METHODS: This study included 8297 adults who have records of COVID-19 test results from UK Biobank (from 16 March 2020 to 29 June 2020). The use of vitamin D supplements, circulating vitamin D levels, and main covariates were measured at baseline (2006-2010). Genetically predicted vitamin D levels were evaluated by genetic risk score. RESULTS: After adjustment for covariates, the habitual use of vitamin D supplements was significantly associated with a 34% lower risk of COVID-19 infection (OR, 0.66; 95% CI, 0.45-0.97; P = 0.034). Circulating vitamin D levels at baseline or genetically predicted vitamin D levels were not associated with the risk of COVID-19 infection. The association between the use of vitamin D supplements and the risk of COVID-19 infection did not vary according to the different levels of circulating or genetically predicted vitamin D (P-interactions = 0.75 and 0.74, respectively). CONCLUSIONS: Our findings suggest that habitual use of vitamin D supplements is related to a lower risk of COVID-19 infection, although we cannot rule out the possibility that the inverse association is due to residual confounding or selection bias. Further clinical trials are needed to verify these results.

Low plasma 25(OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study.

Vitamin D deficiency is a worldwide pandemic. The aim of this study was to evaluate associations of plasma 25(OH)D levels with the likelihood of coronavirus disease 2019 (COVID-19) infection and hospitalization. The study population included the 14 000 members of Leumit Health Services, who were tested for COVID-19 infection from February 1st to April 30th , 2020, and who had at least one previous blood test for the plasma 25(OH)D level. 'Suboptimal' or 'low' plasma 25(OH)D level was defined as plasma 25-hydroxyvitamin D, or 25(OH)D, concentration below the level of 30 ng/mL. Of 7807 individuals, 782 (10.02%) were COVID-19-positive, and 7025 (89.98%) COVID-19-negative. The mean plasma vitamin D level was significantly lower among those who tested positive than negative for COVID-19 [19.00 ng/mL (95% confidence interval (CI) 18.41-19.59) vs. 20.55 (95% CI: 20.32-20.78)]. Univariate analysis demonstrated an association between the low plasma 25(OH)D level and increased likelihood of COVID-19 infection [crude odds ratio (OR) of 1.58 (95% CI: 1.24-2.01, P < 0.001)], and of hospitalization due to the SARS-CoV-2 virus [crude OR of 2.09 (95% CI: 1.01-4.30, P < 0.05)]. In multivariate analyses that controlled for demographic variables, and psychiatric and somatic disorders, the adjusted OR of COVID-19 infection [1.45 (95% CI: 1.08-1.95, P < 0.001)] and of hospitalization due to the SARS-CoV-2 virus [1.95 (95% CI: 0.98-4.845, P = 0.061)] were preserved. In the multivariate analyses, age over 50 years, male gender and low-medium socioeconomic status were also positively associated with the risk of COVID-19 infection; age over 50 years was positively associated with the likelihood of hospitalization due to COVID-19. We concluded that low plasma 25(OH)D levels appear to be an independent risk factor for COVID-19 infection and hospitalization.