Association of Vitamin D with Severity and Outcome of COVID-19: Clinical and Experimental Evidence

Long-term effects of COVID-19 infection on bone mineral density

Background

In this study, we aimed to identify bone mineral density (BMD) trajectories of hospitalised patients with coronavirus disease 2019 (COVID-19) and to determine the prognostic role of the trajectory groups.

Methods

This is a retrospective study of hospitalised patients with COVID-19 treated in our hospital from November 2022 to February 2023. BMD was manually measured from the thoracic 12 (T12) and lumbar one (L1) vertebra using chest computed tomography images. We constructed group trajectory models using group-based trajectory modelling. We performed the logistic regression analysis to associate the BMD trajectory pattern with clinical outcomes.

Results

This study included 1767 patients. The mean follow-up time after discharge was 181.5 days (standard deviation (SD) = 9.7). There were 1137 (64.3%) male patients, and more than 80% of patients were aged >60 years. We successfully identified three latent BMD trajectories to reveal the dynamic effects of COVID-19 infection on bone health in patients, namely, the early low-normal decline group, the average, and the early high-rapid decline group. All groups demonstrated consistent overall declining trends. A significant association was observed between BMD trajectory pattern (T12 or L1) and baseline characteristics of sex, age, and penetrating keratoplasty (P < 0.05). Our study showed that the BMD trajectories were significantly associated with mortality. Furthermore, we found that these trajectories were also associated with the length of hospital stay.

Conclusions

This study provided evidence for the COVID-19 process to bone health, as well as evidence on strengthening bone health management before and after COVID-19 infection. BMD trajectories may help manage bone health and guide treatment in patients with COVID-19.

Effects of an 8-week high-dose vitamin D supplementation on fatigue and neuropsychiatric manifestations in post-COVID syndrome: A randomized controlled trial

AIM

This study evaluated the effectiveness of high-dose vitamin D supplementation in alleviating fatigue and neuropsychiatric symptoms in post-COVID syndrome.

METHODS

In an 8-week, double-blind, randomized, placebo-controlled trial, 80 patients with post-COVID fatigue or neuropsychiatric symptoms were enrolled. Participants were randomly assigned to receive either 60,000 IU of vitamin D weekly (n = 40) or a placebo (n = 40) for 8 weeks. Clinical outcomes were assessed using the 11-item Chalder Fatigue Scale (CFQ-11); 21-item Depression, Anxiety, and Stress Scale (DASS-21); Pittsburgh Sleep Quality Index (PSQI); Addenbrooke's Cognitive Examination III (ACE); and Trail Making Test A and B (TMT-A and TMT-B). Baseline and 8-week measurements of inflammatory markers, including interleukin 6 (IL-6) and C-reactive protein (CRP), were also collected.

RESULTS

Significant improvements were found in the vitamin D group for CFQ (coefficient -3.5, P = 0.024), DASS-anxiety (-2.0, P = 0.011), and ACE (2.1, P = 0.012). No significant differences were observed in PSQI, DASS-depression, TMT, IL-6, or CRP levels. The incidence of adverse events was comparable between groups, with no serious adverse events reported.

CONCLUSION

High-dose vitamin D supplementation may benefit patients with post-COVID syndrome by reducing fatigue, alleviating anxiety, and improving cognitive symptoms, with minimal side effects.

Serum vitamin D levels and the severity and clinical course of COVID-19

Low vitamin D levels are associated with different pulmonary diseases, such as chronic obstructive pulmonary disease, bronchial asthma, and obstructive sleep apnea. In this study, we aimed to assess the relation between vitamin D levels and COVID-19 severity. Positive COVID-19 patients were subjected to clinical examination, computed tomography of the chest, and laboratory investigations. Serum vitamin D level was measured and correlated with the severity and the clinical course of the disease. The study included 72 patients, classified into four groups according to the severity of the disease. There was a statistically significant difference between the four groups regarding age, lymphocyte count, serum vitamin D, C-reactive protein, and lactate dehydrogenase levels. Serum vitamin D levels can be correlated with COVID-19 severity and clinical course.

Randomized trial of influence of vitamin D on the prevention and improvement of symptomatic COVID-19

We aimed to investigate the preventive effect of vitamin D2 on COVID-19 and the improvement of symptoms after COVID-19 infection. The study recruited 228 health care workers who tested negative PCR or antigen for COVID-19. Subjects were randomly allocated to vitamin D2 or non-intervention at a ratio 1:1. Subjects recorded PCR or antigen tests and the symptoms of COVID-19 twice a week during the follow-up visit. The concentration of serum 25-hydroxyvitamin D (25(OH)D), C-reaction protein (CRP), complement component C1q and inflammatory cytokines were measured. The rates of COVID-19 infection were 50.5% in the vitamin D2 group and 52.4% in the non-intervention group (P = 0.785). There was no difference in the COVID-19 symptoms between the two groups. The mean 25(OH)D level significantly increased from 14.1 to 31.1 ng/mL after administration (P < 0.001). The difference between the two groups was not significant for the concentrations of CRP, C1q and inflammatory cytokines on the thirtieth day of the trial. According to the second level of vitamin D, there was a 14.3% difference in positive infection rates between the vitamin D adequate (> 30 ng/mL) and deficient groups (< 20 ng/mL). Adequate vitamin D had a tendency to prevent COVID-19.Trial registration: ClinicalTrials.gov NCT05673980, dated: 12/2022.

Vitamin D Levels in COVID-19 and NonCOVID-19 Pediatric Patients and Its Relationship with Clinical and Laboratory Characteristics

25-hydroxyvitamin D [25(OH)D] is a marker with an important role in regulating the inflammatory response. Low concentrations of this vitamin are often found among the population, correlated with increased risk of respiratory tract infections. The aim of the study is to evaluate the relationship between vitamin D levels and clinical and laboratory markers in children and adolescents hospitalized with and without COVID-19. A retrospective study, including all patients tested for SARS-CoV-2 and having vitamin D measured, was performed. All included hospitalized cases, 78 COVID-19 patients and 162 NonCOVID-19 patients, were divided into subgroups according to their 25(OH)D serum levels (<20 ng/mL-deficiency, 20-30 ng/mL-insufficiency, ≥30 ng/mL-normal or <30 ng/mL, ≥30 ng/mL) and age (≤2 years, >2 years). Vitamin D deficiency and insufficiency increased with age, in both COVID-19 and NonCOVID-19 groups. All symptoms were encountered more frequently in cases of pediatric patients with COVID-19 in comparison with NonCOVID-19 cases. The most frequently encountered symptoms in the COVID-19 group were fever, loss of appetite, and nasal congestion. In the NonCOVID-19 group, serum 25(OH)D concentrations were positively correlated with leukocytes, lymphocytes, and LMR and negatively correlated with neutrophils, NLR, and PLR while no significant correlation was observed in the case of COVID-19 group. Differences between vitamin D status and clinical and laboratory parameters were observed, but their clinical significance should be interpreted with caution. The results of this study may offer further support for future studies exploring the mechanisms of the relationship between vitamin D and clinical and laboratory markers as well as for studies investigating the implications of vitamin D deficiency/supplementation on overall health/clinical outcomes of patients with/without COVID-19.

Vitamin D in Health and Disease 2.0

Vitamin D (VD) is a fat-soluble vitamin considered essential for human health, and its levels are associated with the function and composition of the intestinal microbiome [...].