Title : The impact of D vitamin deficiency in the course and resolution of Covid -19
Abstract:
Background: Several studies suggest an association between serum 25-hydroxyvitamin D (25OHD) and the outcomes of Corona-Virus-2 (SARS-CoV-2) infection, in particular COVID-19 Pandemic related severity and mortality. The aim of the present was to investigate whether vitamin D status is associated with the COVID-19 severity, defined as referrals to hospital, admission to intensive care unit (ICU), the requirement of oxygen supply and to reveal the most prevalent symptoms associated with vitamin D status.
Methods: 384 patients infected by SARS-CoV-2 during COVID-19 pandemic were selected in the presented retrospective study after obtaining the informed consent for the participation. Their medical records were obtained from medical databases of National Center of Disease Control of Georgia. The survey by special structural questionnaire was carried out by trained doctor using the phone interview. The study group was divided according vitamin D status: the group 1 (n=83) – patients with vitamin D level in blood plasma less than 12 ng/dl; the group 2 (n=141) – patients with vitamin D level in blood plasma in the range 12-19.9 ng/dl; and group 3 (n=160) - patients with vitamin D level in blood plasma more or equal to 20 ng/dl. The assessed clinical outcomes were the rates of the admission to hospital, admission to ICU, the requirement of the oxygen supply and the treatment by glucocorticoids. The studied symptoms were - fever, cough, shortness of breath, general fatigue, loss of smell/taste, chest pain, rhinitis, dizziness, arrhythmia. The categorical variables are presented as the percentages. Odds ratio (OR) with 95% confidence intervals (95%CI) was used to assess the difference of the defined outcomes between the groups. The criterion to reject the null hypothesis was p<0.05.
Results: COVID-19 hospitalization rate in the group 1 was 31.3%, in the group 2 - 5.0%, and in the group 3 - 7.5%. OR between groups 1 and 2 was 8.73 (95%CI 3.58 – 21.27, F-test = 4.96, p<0.001). OR between groups 1 and 3 was 5.62 (95%CI 2.66 – 11.90, F-test = 4.52, p<0.001). OR between groups 2 and 3 was not significant. The rates of the admission to ICU between the groups were too small. Therefore, the differences between the groups for this parameter were not significant. The rate of the requirement of oxygen supply during hospitalization in the group 1 was 16.9%, %, in the group 2 - 0.7%, and in the group 3 - 3.8%. OR between groups 1 and 2 was 28.41 (95%CI 3.66 – 220.47, F-test = 3.20, p=0.001). OR between groups 1 and 3 was 5.21 (95%CI 1.92 – 14.12, F-test = 3.24, p=0.001). OR between groups 2 and 3 was not significant. The rate of the treatment by glucocorticoids during hospitalization in the group 1 was 9.6%, %, in the group 2 - 2.8%, and in the group 3 - 1.3%. OR between groups 1 and 2 was 3.65 (95%CI 1.06 – 12.53, F-test = 2.06, p=0.039). OR between groups 1 and 3 was 8.43 (95%CI 1.75 – 40.65, F-test = 2.66, p=0.008). OR between groups 2 and 3 was not significant. The most prevalent symptoms associated with vitamin D status were: fever, cough, shortness of breath, general fatigue, loss of smell/taste, and chest pain.
Conclusions: Patients with low vitamin D levels presented an increased risk of the requiremet for the admission to hospital, the oxygen supply, and the treatment by glucocorticoids due to SARS-CoV-2 infection. The most prevalent symptoms associated with vitamin D status were: fever, cough, shortness of breath, general fatigue, loss of smell/taste, and chest pain.
