Association of vitamin D with the severity of disease and mortality in COVID-19: Prospective study in central India

Background

Many factors have been proposed to be associated with the severity of disease and mortality in COVID-19. Vitamin D had recently been reviewed as one of these factors.

Aim and Objectives

To evaluate the association between Vitamin D and the disease severity and mortality in COVID-19.

Materials and Methods

After approval from Institutional Ethics Committee, this prospective cohort study was carried out in selected tertiary care teaching medical institutes of Central India. Participants were COVID-19 patients of the age group of 18 years and above admitted during the study period. They were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. Serum level of Vitamin 25(OH) D was measured using chemiluminescent immunoassay. The outcome of the disease was classified as recovery and death during hospitalization. The association of sociodemographic and medical characteristics with treatment outcome was studied using an appropriate statistical test. A full logistic regression model was built for the assessment of the relationship between treatment outcomes with Vitamin D level. Further, one receiver operating characteristic curve was developed to examine the prognostic significance of Vitamin D levels in COVID-19 patients.

Results

Out of 748 enrolled patients, 44 (5.88%), had severe disease (Group D). A total of 721 cases (96.39%) recovered and were discharged, whereas 27 (3.61%) died during hospitalization. Mean Vitamin D level was found to be significantly different in discharged patients compared to those who were deceased. Increasing age-adjusted odds ratio (AOR) (95% confidence interval [CI]=1.07 [1.02-1.12]), known hypertension AOR (95%CI) = 3.38 (1.13-10.08), and diabetes mellitus AOR (95%CI) =28.5 (6.04-134.13) were found to be significant predictors of death among COVID-19 patients. Increasing Vitamin D level was found to be protective against COVID-19-related death (AOR (95% CI = 0.87 [0.80-0.94]).

Conclusion

Vitamin D was significantly associated with the disease severity and mortality in COVID-19.

The study of association of serum ischemia-modified albumin and prediabetes in women: A case–control study

Background: Prediabetes, diabetes, and their associated complications adversely affect women’s health worldwide. Women in the reproductive age group are more prone for developing diabetes and its associated complications such as gestational diabetes and infertility. Hence, it is the need of the hour to diagnose women at risk of pre-diabetes. Oxidative stress, ischemia, and hypoxia have been suggested as important factors in developing prediabetes and its sequels. Aims and Objectives: The present study aimed to study the association of serum ischemia-modified albumin (IMA), namely, a marker of oxidative stress, ischemia, and hypoxia with prediabetes in the women of reproductive age group. Materials and Methods: The present study was carried out in 50 females in the reproductive age group of 19–45 years. The study population was further sub-divided into two groups: Group I consisted of 25 prediabetic patients and Group II consisted of 25 healthy controls. Serum samples of the subjects were analyzed for serum IMA, blood sugar profile, and other routine biochemistry tests. Results: The present study showed that mean serum IMA was raised in prediabetic group as compared to healthy controls. The serum IMA also positively correlated with blood sugar profile. Conclusion: Increased serum IMA could be used as a biomarker for predicting prediabetes in females of reproductive age group. This, in turn, would be helpful in preventing the burden of various complications known to occur in the natural course of prediabetes and diabetes.

The study of serum hsCRP, ferritin, IL-6 and plasma D-dimer in COVID-19: a retrospective study

OBJECTIVES

The cut off values for serum high sensitivity C-reactive protein (hsCRP), ferritin, interleukin 6 (IL-6) and plasma D-dimer could be of profound help in detecting COVID-19 patients at risk of adverse outcomes. Therefore, the aim of the present study is to determine the cut off values of the serum hsCRP, ferritin, IL-6 and plasma D-dimer in predicting mortality in COVID-19 patients.

METHODS

Four hundred RT-PCR confirmed cases of COVID-19 were sub divided into two groups based on their outcome during hospitalisation. Group I consisted of survivors and Group II consisted of non-survivors. The survivors were further divided into three sub-groups: mild, moderate and severe based on the severity of infection. The laboratory data of serum hsCRP, ferritin, IL-6 and plasma D-dimer for all these patients was retrieved from the Medical Record Section of the Hospital.

RESULTS

Mean serum hsCRP, ferritin, IL-6 and plasma D-dimer levels were significantly higher in non-survivors as compared to survivors of COVID-19. The levels of these biomarkers correlated with the severity of COVID-19 illness. ROC curve analysis revealed that plasma D-dimer is having a better predictive value as compared to other parameters in predicting mortality in COVID-19.

CONCLUSIONS

The serum hsCRP, ferritin, IL-6 and plasma D-dimer levels could be used in risk stratification of COVID-19 patients. The optimum cut off given by the current study could be considered in predicting adverse outcome in these patients. Amongst the many studied biomarkers, plasma D-dimer might be the best early biomarker to predict mortality in COVID-19 patients.