Vitamin D status and its association with the severity of COVID-19 among hospitalized patients

Abir Hasan Dip; Shaiful Azam Quadry; M. Shariful Alam; M. Tanimul Haque Rijvy; Uma Dhar; Shilpy Akter; Hosneara Parvin; Mohammad Arbab Sarker; Shamim Ahmed; Rajashish Chakrobortty

doi:10.18203/2349-3933.ijam20241623

Authors

Abir Hasan Dip Department of Cardiology, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh
Shaiful Azam Quadry Upazila Health Complex, Asamganj, Brahamanbaria, Bangladesh
M. Shariful Alam OSD, DOHS, Mohakhali, Dhaka, Bangladesh
M. Tanimul Haque Rijvy Jashore Medical College Hospital, Jashore, Bangladesh
Uma Dhar Department of Medicine, OSD, DOHS, Mohakhali, Dhaka, Bangladesh
Shilpy Akter Department of Dermatology, 250 Bedded Mohammad Ali Hospital, Bogura, Bangladesh
Hosneara Parvin 250 Bedded General Hospital, Jashore, Bangladesh
Mohammad Arbab Sarker Department of Paediatrics, OSD, DOHS, Mohakhali, Dhaka, Bangladesh
Shamim Ahmed Department of Respiratory Medicine, BSMMU, Dhaka, Bangladesh
Rajashish Chakrobortty Department of Respiratory Medicine, BSMMU, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2349-3933.ijam20241623

Keywords:

COVID-19, Coronavirus disease 2019, SARS-CoV-2, ARDS

Abstract

Background: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), causing COVID-19, manifests with outcomes ranging from mild to severe, even fatal. The reason for severe symptoms remains unclear. Vitamin D is implicated in the pathogenesis of severe COVID-19, including ARDS, cytokine storms, and thrombotic complications. The aim of this study was evaluation of vitamin D status and its association with the severity of COVID-19 patients attending Bangabandhu Sheikh Mujib medical University (BSMMU).

Methods: This cross-sectional study, conducted at BSMMU, Dhaka from January to December 2021, included 103 adult COVID-19-positive patients from both genders. Disease severity was assessed using WHO guidelines, and vitamin D levels recorded. Data were collected using a pre-designed datasheet after obtaining written informed consent.

Results: Among 103 COVID-19 patients, 55.3% were vitamin D deficient, 26.2% insufficient, and 18.4% sufficient. Most were male (65%) in their sixth and seventh decades. The mean vitamin D level was 20.97±10.96 ng/ml with a median of 18.10 ng/ml. Vitamin D deficiency was highest among critical patients (84.6%), followed by severe (71.1%), moderate (41.9%), and mild (28.6%) cases (p<0.001). Severe patients had a significantly higher deficiency rate (74.5%) compared to non-severe (36.5%) cases (p<0.001). Symptoms such as cough (96.5%), fever (89.5%), and shortness of breath (78.9%) were prevalent in the vitamin D deficiency group.

Conclusions: This study reveals a 55% prevalence of vitamin D deficiency in COVID-19 patients, correlating independently with disease severity. Hypertension and diabetes are notable comorbidities. It underscores the importance of assessing vitamin D levels in clinical practice.

Metrics

Metrics Loading ...

References

Maghbooli Z, Sahraian MA, Ebrahimi M, Pazoki M, Kafan S, Tabriz HM, et al. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PloS one. 2020;15(9):e0239799.

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 College Nutr. 2021;40(8):724-31.

Worldometer2022, Countries where COVID-19. 2022. Available at: https: www.worldometers.info/coronavirus/countries-where-coronavirus-has-spread/. Accessed on 10 April, 2024.

Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: what we know. Int J Infect Dis. 2020;94:44-8.

Verdoia M, De Luca G. Potential role of hypovitaminosis D and vitamin D supplementation during COVID-19 pandemic. Int J Med. 2021;114(1):3-10.

Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of vitamin D status and other clinical characteristics with COVID-19 test results. JAMA Network Open. 2020;3(9):e2019722.

Baktash V, Hosack T, Patel N, Shah S, Kandiah P, Van den Abbeele K, et al. Vitamin D status and outcomes for hospitalised older patients with COVID-19. Postgraduate Med J. 2021;97(1149):442-7.

Mohan M, Cherian JJ, Sharma A. Exploring links between vitamin D deficiency and COVID-19. PLoS Pathogens. 2020;16(9):e1008874.

Razdan K, Singh K, Singh D. Vitamin D levels and COVID-19 susceptibility: is there any correlation? Med Drug Discovery. 2020;7:100051.

Zwart SR, Smith SM. Vitamin d and covid-19: lessons from spaceflight analogs. J Nutr. 2020;150(10):2624-7.

Lau FH, Majumder R, Torabi R, Saeg F, Hoffman R, Cirillo JD, et al. Vitamin D insufficiency is prevalent in severe COVID-19. MedRxiv. 2020;1-14.

Islam AM, Hasan MN, Rahman KM, Asaduzzaman M, Rahim MA, Zaman S, et al. Vitamin D status in Bangladeshi subjects: a laboratory-based study. BIRDEM Med J. 2019;9(3):202-6.

Ghasemian R, Shamshirian A, Heydari K, Malekan M, Alizadeh-Navaei R, Ebrahimzadeh MA, et al. The Role of Vitamin D in The Age of COVID-19: A Systematic Review and Meta-Analysis Along with an Ecological Approach. Int J Clin Pract. 2021;75(11):e14675.

Green SB. How many subjects does it take to do a regressionanalysis. Multivariate Behavioral Res. 1991;26(3):499-510.

Carpagnano GE, Di Lecce V, Quaranta VN, Zito A, Buonamico E, Capozza E, et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J Endocrinological Investigation. 2021;44(4):765-71.

Mamani M, Muceli N, Basir HRG, Vasheghani M, Poorolajal J. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study. Int J General Med. 2017;10:423.

Dancer RC, Parekh D, Lax S, D'Souza V, Zheng S, Bassford CR, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax. 2015;70(7):617-24.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Eng J Med. 2020;382(18):1708-20.

Farsalinos K, Bagos PG, Giannouchos T, Niaura R, Barbouni A, Poulas K. Smoking prevalence among hospitalized COVID-19 patients and its association with disease severity and mortality: an expanded re-analysis of a recent publication. Harm Reduction J. 2021;18(1):1-9.

Mohsin FM, Tonmon TT, Nahrin R, Tithy SA, Ame FA, Ara I, et al. Association Between Smoking and COVID-19 Severity: Evidence from Bangladesh. J Multidisciplinary Healthcare. 2021;141923.

Almehmadi M, Turjoman A, El-Askary A, Shafie A, Rebh F, Alenazi M, et al. Association of vitamin D deficiency with clinical presentation of COVID-19. Eur J Inflammation. 2021;19:1-10.

Karahan S, Katkat F. Impact of serum 25 (OH) vitamin D level on mortality in patients with COVID-19 in Turkey. J Nutrit Health Aging. 2021;25(2):189-96.

Radujkovic A, Hippchen T, Tiwari-Heckler S, Dreher S, Boxberger M, Merle U. Vitamin D Deficiency and Outcome of COVID-19 Patients. Nutrients. 2020;12(9):2757.