Vitamin D as a laboratory predictor of mortality in COVID-19 patients admitted in intensive care

Document Type : Original papers

Authors

Department of critical care medicine , Faculty of medicine , Beni-Suef University

Abstract

Background: Multiple blood markers were correlated with poor clinical results in severely ill COVID-19 patients. Published reports correlated C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte Ratio (NLR), D-dimer, serum ferritin, and vitamin D levels, with adverse outcomes and an enhanced mortality rate in vitally ill COVID-19 patients; yet, evidence is not enough to guide management for the patients using the predictive values of the above mentioned markers. Objectives: to assess the impact of vitamin D on the outcomes of COVID-19 patients who were extremely ill.  Methods: We conducted prospective research on 40 COVID-19 patients who were critically sick and hospitalized to the intensive care unit (ICU) of a chest isolation hospital in Beni Suef, Egypt (COVID intensity score ≥  8). Vitamin D concentrations in blood were determined at admission and 48 hours later. Results: There were 40 patients total, with an average age of 55.6 ±9.9 years and a non-statistical significance between both sexes. With a median duration of 15 days, mechanical breathing was necessary for 62.5% of the patients (invasive and non-invasive). There was a clinical correlation between death and male sex, the existence of diabetes mellitus, bilateral pulmonary infiltration, and heart failure, despite these correlations being statistically insignificant. After admission, serum vitamin D levels did not significantly influence mortality prediction; however, 48 hours later, vitamin D significantly affected mortality prediction, with Area under curve (0,886) and sensitivity (81,8), specificity (83,3), PPV (85,7), and NPV (78,9) at a cut-off ≤ 18. Conclusions: vitamin D useful as a predictor for mortality. Many demographic and clinical factors must be correlated with , when interpretating this biomarker .

Keywords

References

  1. Abdel-Ghaffar, Muhammad M., et al. "Prediction of mortality in hospitalized Egyptian patients with Coronavirus disease-2019: A multicenter retrospective study." Plos one, Vol. 17, No. 1, 2022, p.e0262348.
  2. Omran, Dalia, et al. "Predictors of severity and development of critical illness of Egyptian COVID-19 patients: A multicenter study" Plos one, Vol. 16, No. 9, 2021, p. e0256203.
  3. Infante, Marco, et al. "Hydroxychloroquine in the COVID-19 pandemic era: in pursuit of a rational use for prophylaxis of SARS-CoV-2 infection." Expert review of anti-infective therapy, Vol. 19, No. 1, 2021, pp. 5-16.
  4. Liu, Jing, et al. "Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients." EBioMedicine, Vol. 55, 2020.
  5. Huang, Chaolin, et al. "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China." The lancet, Vol. 395, No. 10223, 2020, pp. 497-06.
  6. Moore, John B., and Carl H. June. "Cytokine release syndrome in severe COVID-19." Science, Vol. 368, No. 6490, 2020, pp. 473-74.
  7. Ye, Qing, Bili Wang, and Jianhua Mao. "The pathogenesis and treatment of the Cytokine Storm'in COVID-19." Journal of infection, Vol. 80, No. 6, 2020, pp. 607-13.
  8. Zaim, Sevim, et al. "COVID-19 and multiorgan response." Current problems in cardiology, Vol. 45, No. 8, 2020, p. 100618.
  9. Zhou, Fei, et al. "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study." The Lancet, Vol. 395, No. 10229, 2020, pp. 1054-62.
  10. Tang, Ning, et al. "Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia." Journal of thrombosis and haemostasis, Vol. 18, No. 4, 2020, 844-47.
  11. Caprio, Massimiliano, et al. "Vitamin D: not just the bone. Evidence for beneficial pleiotropic extraskeletal effects." Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, Vol. 22, No. 1, 2017, pp. 27
  12. Fabbri, A., M. Infante, and C. Ricordi. "Editorial-Vitamin D status: a key modulator of innate immunity and natural defense from acute viral respiratory infections." European Review for Medical Pharmacological
  13. Infante, Marco, et al. "The role of vitamin D and omega-3 PUFAs in islet transplantation." Nutrients, Vol. 11, No. 12, 2019, p. 2937.
  14. Charoenngam, Nipith, and Michael F. Holick. "Immunologic effects of vitamin D on human health and disease." Nutrients, Vol. 12, No. 7, 2020, p. 2097.
  15. Infante, Marco, et al. "Influence of vitamin D on islet autoimmunity and beta-cell function in type 1 diabetes." Nutrients, Vol. 11, No. 9, 2019, p. 2185.
  16. Holick, Michael F. "The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention." Reviews in Endocrine and Metabolic Disorders, Vol. 18, No. 2, 2017, pp. 153-65.
  17. Martineau, Adrian R., and Nita G. Forouhi. "Vitamin D for COVID 19: a case to answer?." The Lancet Diabetes & Endocrinology, Vol. 8, No. 9, 2020, pp. 735-36.
  18. Infante, Marco, et al. "Low vitamin D status at admission as a risk factor for poor survival in hospitalized patients with COVID-19: an Italian retrospective study." Journal of the American Nutrition Association, Vol.
  19. Huespe, Iván, et al. "COVID-19 Severity Index: A predictive score for hospitalized patients." Medicina intensiva, Vol. 46, No. 2, 2022, p. 98.
  20. Singer, Mervyn, et al. "The third international consensus definitions for sepsis and septic shock (Sepsis-3)." Jama, Vol. 315, No. 8, 2016, pp. 801-10
  21. Prokop, Mathias, et al. "CO-RADS: a categorical CT assessment scheme for patients suspected of having COVID-19—definition and evaluation." Radiology, Vol. 296, No. 2, 2020, pp. 97-04.
  22. Ilie PC, Stefanescu S, Smith, The role of vitamin D in prevention of coronavirus disease 2019 infection and mortality. Aging clin Exp Res 2020, http://dx.doi.org/10.1007/s40520-020-01570-8
  23. Maghbooli Z, Sahraian MA, Ebrahimi M, Pazoki M, Kafan S, Tabriz HM, et al. vitamin D sufficiency, a serum 25- hydroxyl vitamin D at least 30 ng / ml reduced risk for adverse clinical outcomes in patients with COVID-19 INFECTION. Plos one .2020 sep 25;15(9): e0239799. https://doi.org/10.1371/journal pone 0239799
  24. De Smet D, De Smet K , Herroelen P, GryspeerdtS, Martens GA. Serum 25(OH)D level on hospital admission associated with COVID-19 stage and mortality. Am J Clin Pathol. 2021; 155 (3):3818. https://doi.org/10.1093/ajcp/aqaa252.
  25. Raharusum P, Priamabada S, Budiarti C, Agung E, Budi C. Patterns of COVID-19 mortality and vitamin D an Indonesian study. SSRN J 2020, http://dx.doi.org/10.2139/ssrn.3585561
  26. Available online on https://doi.org/10.1186/s12879-021-06369-0

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