BACKGROUND: In many studies, vitamin D has been found to be low in COVID-19 patients. In this study, we aimed to investigate the relationship between clinical course and inhospital mortality with parenteral administration of high-dose vitamin D 3 within the first 24 h of admission to patients who were hospitalized in the intensive care unit (ICU) because of COVID-19 with vitamin D deficiency. METHODS: This study included 175 COVID-19 patients with vitamin D deficiency [25(OH) D <12 ng/mL] who were hospitalized in the ICU. Vitamin D 3 group (n = 113) included patients who received a single dose of 300,000 IU vitamin D3 intramuscularly. Vitamin D 3 was not administered to the control group (n = 62). RESULTS: Median C-reactive protein level was 10.8 mg/dL in the vitamin D 3 group and 10.6 mg/dL in the control group (p = 0.465). Thirty-nine percent (n = 44) of the patients in the vitamin D 3 group were intubated endotracheally, and 50% (n = 31) of the patients in the control group were intubated endotracheally (p = 0.157). Parenteral vitamin D 3 administration was not associated with inhospital mortality by multivariate logistic regression analysis. According to Kaplan-Meier survival analysis, the median survival time was 16 d in the vitamin D3 group and 17 d in the control group (log-rank test, p = 0.459). CONCLUSION: In this study, which was performed for the first time in the literature, it was observed that high-dose parenteral vitamin D 3 administration in critical COVID-19 patients with vitamin D deficiency during admission to the ICU did not reduce the need for intubation, length of hospital stay, and inhospital mortality.

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Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection can cause thyroid hormonal disorders. In addition, tracheal compression by thyroid nodules can aggravate hypoxia in critically ill patients. No studies have investigated the effect of thyroid nodules on the prognosis of patients with COVID‐19. In this study, we investigated the effect of thyroid hormonal disorders and thyroid nodules on the prognosis of patients with COVID‐19. Materials and Methods This prospective study was conducted at the Şırnak State Hospital (Pandemic hospital in Turkey) between 15 March and 15 August 2020. We evaluated thyroid hormonal disorder and thyroid nodules in 125 patients who were admitted to the non‐intensive care unit (non‐ICU) due to mild COVID‐19 pneumonia (group 1) and 125 critically ill patients who were admitted to the ICU (group 2). Results Thyroid‐stimulating hormone levels (TSH) were not significantly different between groups 1 and 2; however, group 2 patients had significantly lower levels of free thyroxine (FT4) and free triiodothyronine (FT3) as compared to group 1 (P = .005, P < .0001, respectively). FT3 level showed a negative correlation with length of hospital stay and C‐reactive protein level (rho: −0.216, p: 0.001; rho: −0.383, P < .0001). Overt thyroid disorder was observed in 13 patients [2 patients in group 1 (both with overt thyrotoxicosis) and 11 patients in group 2 (3 overt hypothyroidism, 8 overt thyrotoxicosis) (P = .01)]. Thyroid nodules sized ≥1 cm were found in 9 patients (7%) in group 1 and 32 patients (26%) in group 2 (P < .0001). Conclusion Overt thyroid hormonal disorders were more common in critically ill COVID‐19 patients. FT3 level at hospital admission is a potential prognostic marker of COVID‐19 patients. Thyroid nodules may be associated with severe COVID‐19 disease.

BACKGROUND: Critical diseases usually cause hypercortisolemia via activation of the hypothalamic-pituitary-adrenal axis. OBJECTIVES: To investigate the relationship between serum total cortisol level and mortality among coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU), at the time of their admission. DESIGN AND SETTING: Prospective study developed in a pandemic hospital in the city of Şırnak, Turkey. METHODS: We compared the serum total cortisol levels of 285 patients (141 COVID-19-negative patients and 144 COVID-19-positive patients) followed up in the ICU. RESULTS: The median cortisol level of COVID-19-positive patients was higher than that of COVID-19 negative patients (21.84 μg/dl versus 16.47 μg/dl; P < 0.001). In multivariate logistic regression analysis, mortality was associated with higher cortisol level (odds ratio: 1.20; 95% confidence interval: 1.08-1.35; P = 0.001). The cortisol cutoff point was 31 μg/dl (855 nmol/l) for predicting mortality among COVID-19-positive patients (area under the curve 0.932; sensitivity 59%; and specificity 95%). Among the COVID-19 positive patients with cortisol level ≤ 31 μg/dl (79%; 114 patients), the median survival was higher than among those with cortisol level > 31 μg/dl (21%; 30 patients) (32 days versus 19 days; log-rank test P < 0.001). CONCLUSION: Very high cortisol levels are associated with severe illness and increased risk of death, among COVID-19 patients in the ICU.

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