Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19
J Am Coll Nutr. 2021 Jan 12;1-11. doi: 10.1080/07315724.2020.1856013
Salam Bennouar 1, Abdelghani Bachir Cherif 2, Amel Kessira 3, Djamel-Eddine Bennouar 3, Samia Abdi 1 (Algeria)
- Less COVID-19 infection, mortality in countries with higher Vitamin D (Asia in this case) – May 2021
- Risk of COVID-19 death was 4.9 X higher if very low vitamin D – March 31, 2021
- COVID-19 mortality 2X higher if low Vitamin D (Mexican hospital, preprint) - March 2021
- All COVID-19 patients had low vitamin D, the lowest were more likely to die – Feb 18, 2021
- 2.7 fewer COVID-19 hospital deaths in those having more than 30 ng of vitamin D – Mayo Jan 9, 2021
- Worse COVID-19 patients got 400,000 IU of vitamin D, deaths cut in half – Jan 14, 2021
- Iranians with COVID-19 were 2.3 X more likely to die if low vitamin D – Jan 2021
- Poor COVID-19 prognosis was 6 X more likely if low vitamin D – Jan 21, 2021
- 30 x fewer COVID-19 deaths in those getting 400,000 IU of Vitamin D - Jan 2021
- 2.8 X fewer COVID-19 nursing home deaths if add 10,000 IU Vitamin D daily for a week (small observation)- Jan 2021
- Italian nursing home COVID-19 – 4X less likely to die if taking Vitamin D– Dec 22, 2020
- Those getting intermittent vitamin D were 7 X less likely to die of COVID-19 - Dec 11, 2020
- COVID-19 male mortality increased 3.9 X if low vitamin D – observation Nov 25, 2020
- Hospital COVID-19 observation: 7X more likely to live if more than 20 ng of vitamin D– Nov 19, 2020
- COVID-19 lung death 4X more likely in Iran if less than 25 ng of vitamin D – Oct 30, 2020
- 9X COVID-19 survival in nursing home if had 80,000 IU dose of vitamin D in previous month – Oct 2020
- 14.7 X more likely to die of COVID-19 if less than 12 ng of Vitamin D (185 Germans) – Sept 10, 2020
- COVID ARDS deaths 2X more likely if less than 10 ng of Vitamin D – Aug 8, 2020
- COVID-19 mortality rate highest North of 35 degrees latitude (Vitamin D) – April 20, 2020
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Background: The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality.
Materials: This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve.
Results: Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (pLog-Rank = 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively.
Hazard ratios were (HR = 6.9, 95% CI [2.0-24.1], p = 0.002 and HR = 6.2, 95% CI [2.1-18.3], p = 0.001) respectively.
Conclusion: This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.