The association between vitamin D levels and the clinical severity and inflammation markers in pediatric COVID-19 patients: single-center experience from a pandemic hospital
Eur J Pediatr. 2021 Mar 31. doi: 10.1007/s00431-021-04030-1
Elvan Bayramoğlu 1, Gülşen Akkoç 2, Ayşe Ağbaş 3, Özlem Akgün 4, Kamer Yurdakul 5, Hatice Nilgün Selçuk Duru 4, Murat Elevli 4
- Children with COVID-19 and low levels of Vitamin D have more severe cases – March 31, 2021
- Vitamin D might reduce Multisystem Inflammatory Syndrome in children – March 2021
- 87 percent of children with COVID–19 had low vitamin D (small study) – Feb 2021
- 13 possible reasons why COVID-19 is less severe in children – Dec 1, 2020
- Vitamin D associated with reduced COVID-19 risks in children - GRH Nov 2020
- Children with low vitamin D far more likely to hospitalized with COVID-19 – Oct 2020
- Respiratory viral infection (RSV) and low vitamin D – July 2020
- Increased weight in children 8X more likely for each unit increase in adenovirus (if ignore Vitamin D) – Nov 2019
- Severe hand, foot, and mouth virus is 2.9 X more likely if poor Vitamin D receptor – Oct 2018
- More US infants die in 1st day than in all other developed countries COMBINED (and US gives vaccine in first day) – May 2013
- Hand, Foot, and Mouth disease (virus) strongly associated with low vitamin D – May 2017
- Half the risk of Influenza -A in infants taking 1200 IU of vitamin D for 4 months – RCT Jan 2018
- Child is 2 X more likely to get influenza if have older sibling (perhaps closely-spaced birth) – Sept 2017
Vitamin D has an immunomodulating property that regulates the inflammatory response. In this study, the aim was to evaluate the relationship between vitamin D levels and clinical severity and inflammation markers in children and adolescents with COVID-19. The clinical and laboratory records of 103 pediatric cases with COVID-19, whose vitamin D levels had been measured, were retrospectively reviewed. The cases were divided into groups according to their clinical severity (asymptomatic, mild, and moderate-to-severe) and vitamin D levels. The moderate-to-severe clinical group had significantly higher inflammation markers (CRP, procalcitonin, fibrinogen, D-dimer) and a lower lymphocyte count compared to both the mild and asymptomatic groups. The 25 OH vitamin D levels were also significantly lower (p < 0.001), and the ratio of vitamin D deficiency was 70.6% in the moderate-to-severe group. The vitamin D-deficient group had a significantly higher age and fibrinogen levels while also having a lower lymphocyte count compared to the insufficient and normal groups. The 25 OH vitamin D level was correlated positively with the lymphocyte count (r = 0.375, p = <0.001), and negatively with age (r = -0.496, p = <0.001), CRP (r = -0.309, p = 0.002) and fibrinogen levels (r = -0.381, p = <0.001). In a logistic regression analysis, vitamin D deficiency, D-dimer, and fibrinogen levels on admission were independent predictors of severe clinical course.
Conclusion: This study revealed an association between vitamin D deficiency and clinical severity, in addition to inflammation markers in pediatric COVID-19 cases. Prophylactic vitamin D supplementation may be considered, especially in the adolescent age group.
What is Known:
- The pathology of COVID-19 involves a complex interaction between the SARS-CoV-2 and the immune system. Hyperinflammation/cytokine storm is held responsible for the severity of the disease.
- Vitamin D has multiple roles in the immune system that can modulate the body reaction to an infection.
What is New:
- Clinically more severe group had significantly lower vit D levels and significantly higher inflammation markers.
- Lower 25 OH vit D levels were associated with higher inflammation markers, suggesting an important role of vitamin D in the clinical course of COVID-19 in children and adolescents probably by regulating the systemic inflammatory response.