ASSOCIATION OF VITAMIN D LEVEL AND SEVERITY OF COVID-19 DISEASE

Authors

  • Amol Singhsakul Department of Internal Medicine, Banphaeo General Hospital
  • Bancha Satirapoj Division of Nephrology, Phramongkutklao Hospital
  • Sirinthip Nimitphuwadon Research Center, Banphaeo General Hospital
  • Sirate Rapeepattana Research Center, Banphaeo General Hospital
  • Saovanee Benjamanukul Department of Internal Medicine, Banphaeo General Hospital
  • Sasiwimon Traiyan Department of Pediatric, Allergy and Asthma Unit, Banphaeo General Hospital

DOI:

https://doi.org/10.55374/jseamed.v8.202

Keywords:

COVID-19, vitamin D deficiency, vitamin D insufficiency, COVID-19 severity

Abstract

Background: Studies indicate that vitamin D can lower the incidence of viral respiratory infections and is necessary for the human immune system to function properly. Vitamin D deficiency may be a risk factor for the severity of COVID-19, including mortality, hospitalization, and length of hospital stay.

Objectives: This study aimed to investigate the association between vitamin D levels and the severity of COVID-19 disease.

Methods: The participants were COVID-19 patients aged 18 years or older who tested positive for the virus on Real-Time PCR tests, treated as inpatients at Banphaeo General Hospital between September 1 and November 30, 2021. For each patient, baseline characteristics, including sex, weight, height, and underlying diseases, were collected. Three categories were used to categorize COVID-19 disease: mild, moderate, and severe. At the beginning of the study, blood tests were performed on each patient to determine their 25-hydroxyvitamin D levels.

Results: Of 97 patients, 64 were male (66%), with a mean age of 50.8±17.7 years. The mean vitamin D level was 27.8±9.6 ng/mL, with 45 (46.4%) showing vitamin D deficiency and 39 (40.2%) indicating vitamin D insufficiency. Among COVID-19 patients with vitamin D deficiency, 28 (63.6%) were classified as severe, compared to only 16 severe cases (36.4%) among those without vitamin D deficiency, demonstrating statistically significant differences (p=0.006). Patients with vitamin D deficiency had a 3.97 times higher risk of experiencing severity (95% CI: 1.67, 9.41, p=0.002) than those without a vitamin D deficit. After adjusting for variable factors, results indicated that patients with vitamin D deficiency had a 3.78-fold increased risk of getting severe illness than those without deficiency (95% CI: 1.28, 11.19, p=0.016). Conclusion: These findings suggested that vitamin D deficiency was associated with the severity of COVID-19.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus disease 2019 (COVID-19): A review. JAMA 2020; 324: 782. DOI: https://doi.org/10.1001/jama.2020.12839

Wolff D, Nee S, Hickey NS, Marschollek M. Risk factors for Covid-19 severity and fatality: a structured literature review. Infection 2021; 49: 15–28. DOI: https://doi.org/10.1007/s15010-020-01509-1

D’Avolio A, Avataneo V, Manca A, Cusato J, De Nicolò A, Lucchini R, et al. 25-hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2. Nutrients 2020; 12: 1359. DOI: https://doi.org/10.3390/nu12051359

Wang Z, Joshi A, Leopold K, Jackson S, Christensen S, Nayfeh T, et al. Association of vitamin D deficiency with COVID‐19 infection severity: Systematic review and meta‐ analysis. Clin Endocrinol (Oxf) 2022; 96: 281-7. DOI: https://doi.org/10.1111/cen.14540

Karatekin G, Kaya A, Salihoğlu Ö, Balci H, Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr 2009; 63: 473–7. DOI: https://doi.org/10.1038/sj.ejcn.1602960

Dimitrov V, White JH. Species-specific regulation of innate immunity by vitamin D signaling. J Steroid Biochem Mol Biol 2016; 164: 246–53. DOI: https://doi.org/10.1016/j.jsbmb.2015.09.016

Sassi F, Tamone C, D’Amelio P. Vitamin D: Nutrient, hormone, and immunomodulator. Nutrients 2018; 10: 1656. DOI: https://doi.org/10.3390/nu10111656

Martineau AR, Jolliffe DA, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, et al. Vitamin D supplementation to prevent acute respiratory infections: individual participant data meta-analysis. Health Technol Assess 2019; 23: 1–44. DOI: https://doi.org/10.3310/hta23020

SACN. Update of rapid review: Vitamin D and acute respiratory tract infections. Accessed November11 2022. https://assetspublishingservicegovuk/government/uploads/system/uploads/attachment_data/file/945179/SACN_December2020_VitaminD_AcuteRespiratoryTractInfectionspdf.

Mercola J, Grant WB, Wagner CL. Evidence regarding vitamin D and risk of COVID-19 and its severity. Nutrients 2020; 12: 3361. DOI: https://doi.org/10.3390/nu12113361

Teshome A, Adane A, Girma B, Mekonnen ZA. The impact of vitamin D level on COVID-19 infection: Systematic review and meta-analysis. Front Public Health 2021; 9: 624559. DOI: https://doi.org/10.3389/fpubh.2021.624559

Shah K, Varna VP, Sharma U, Mavalankar D. Does vitamin D supplementation reduce COVID-19 severity?: a systematic review. QJM 2022; 115: 665–72. DOI: https://doi.org/10.1093/qjmed/hcac040

Ye K, Tang F, Liao X, Shaw BA, Deng M, Huang G, et al. Does serum vitamin D level affect COVID-19 infection and its severity? -A case-control study. J Am Coll Nutr 2021; 40: 724–31. DOI: https://doi.org/10.1080/07315724.2020.1826005

Siwamogsatham O, Ongphiphadhanakul B, Tangpricha V. Vitamin D deficiency in Thailand. J Clin Transl Endocrinol 2015; 2: 48–9. DOI: https://doi.org/10.1016/j.jcte.2014.10.004

COVID-19 Treatment Guidelines. National Institutes of Health (US). 2019; In: Coronavirus Disease 2019 (COVID-19)

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911–30. DOI: https://doi.org/10.1210/jc.2011-0385

Hossein-nezhad A, Holick MF. Vitamin D for health: A global perspective. Mayo Clin Proc 2013; 88: 720–55. DOI: https://doi.org/10.1016/j.mayocp.2013.05.011

Campi I, Gennari L, Merlotti D, Mingiano C, Frosali A, Giovanelli L, et al. Vitamin D and COVID-19 severity and related mortality: a prospective study in Italy. BMC Infect Dis 2021; 21: 566. DOI: https://doi.org/10.1186/s12879-021-06281-7

Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol 2014;n144: 138–45. DOI: https://doi.org/10.1016/j.jsbmb.2013.11.003

Chailurkit L-O, Aekplakorn W, Ongphiphadhanakul B. Regional variation and determinants of vitamin D status in sunshine-abundant Thailand. BMC Public Health 2011; 11: 853. DOI: https://doi.org/10.1186/1471-2458-11-853

Adami G, Rossini M, Bogliolo L, Cantatore FP, Varenna M, Malavolta N, et al. An exploratory study on the role of vitamin D supplementation in improving pain and disease activity in rheumatoid arthritis. Mod Rheumatol 2019; 29: 1059–62. DOI: https://doi.org/10.1080/14397595.2018.1532622

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: 97–115. DOI: https://doi.org/10.1111/joim.13149

Annweiler C, Hanotte B, Grandin de l’Eprevier C, Sabatier J-M, Lafaie L, Célarier T. Vitamin D and survival in COVID-19 patients: A quasi-experimental study. J Steroid Biochem Mol Biol 2020; 204: 105771. DOI: https://doi.org/10.1016/j.jsbmb.2020.105771

Nimitphong H, Holick MF. Vitamin D status and sun exposure in southeast Asia. Dermatoendocrinol 2013; 5: 34–7. DOI: https://doi.org/10.4161/derm.24054

Hansdottir S, Monick MM, Hinde SL, Lovan N, Look DC, Hunninghake GW. Respiratory epithelial cells convert inactive vitamin D to its active form: Potential effects on host defense. J Immunol 2008; 181: 7090–9. DOI: https://doi.org/10.4049/jimmunol.181.10.7090

Jiang J-S, Chou H-C, Chen C-M. Cathelicidin attenuates hyperoxia-induced lung injury by inhibiting oxidative stress in newborn rats. Free Radic Biol Med 2020; 150: 23–9. DOI: https://doi.org/10.1016/j.freeradbiomed.2020.02.005

Aranow C. Journal of investigative medicine : the official publication of the American Federation for Clinical Research 2011; 59 : 881–6. DOI: https://doi.org/10.2310/JIM.0b013e31821b8755

Hanff TC, Harhay MO, Brown TS, Cohen JB, Mohareb AM. Is there an association between COVID-19 mortality and the renin-angiotensin system? A call for epidemiologic investigations. Clin Infect Dis 2020; 71: 870–4. DOI: https://doi.org/10.1093/cid/ciaa329

Murai IH, Fernandes AL, Sales LP, Pinto AJ, Goessler KF, Duran CSC, 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: 1053. DOI: https://doi.org/10.1001/jama.2020.26848

Association between vitamin D deficiency and the severity of COVID-19 disease at moderate and severe levels

Downloads

Published

2024-06-09

How to Cite

1.
Singhsakul A, Satirapoj B, Nimitphuwadon S, Rapeepattana S, Benjamanukul S, Traiyan S. ASSOCIATION OF VITAMIN D LEVEL AND SEVERITY OF COVID-19 DISEASE. J Southeast Asian Med Res [Internet]. 2024 Jun. 9 [cited 2025 Sep. 12];8:e0202. Available from: https://www.jseamed.org/index.php/jseamed/article/view/202

Issue

Section

Original Articles

Most read articles by the same author(s)

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.