Low vitamin D levels and increased neutrophil in patients admitted at ICU with COVID-19

Abstract

Background & Aims Systemic inflammation has been reported as a new predictor for COVID-19 outcomes. Thus, we hypothesized that ICU patients infected by COVID-19 had lower blood vitamin D levels and increased systemic inflammation. Therefore, this is the first Brazilian study to evaluate the vitamin D concentrations and NLR as a systemic inflammation in patients infected by COVID-19 admitted in ICU. Methods This cross-sectional study selected twenty-six patients from COVID-19 Data Sharing/FAPESP, Brazil. Twenty-five patients were enrolled from a single hospital and those with blood vitamin D and neutrophil and lymphocyte data were included and had all available data analyzed. Patients were divided in two groups: low vitamin D concentration when ≤ 20 ng/mL (low Vit D group, n= 8, 5M/3F, 62.7±8.4 years old), and normal vitamin D when > 20 ng/mL (normal Vit D group, n= 17, 9M/8F, 74±8.2 years old). Serum 25-hydroxy-vitamin D, C reactive protein (CRP), and count of neutrophils and lymphocytes concentrations were collected from COVID-19 Data Sharing/FAPESP. Statistical analyses were performed using the Prism version 5.0 and Student T test was applied to verify any difference between the groups. Results Low vitamin D group had 15.5±3.3 ng/mL of 25OH Vit D concentrations and normal vitamin D group had 35.9±8.8 ng/mL. Although no difference between groups for CRP concentrations (low Vit D: 4.5±3.3 vs. normal Vit D: 4.2±4.0 mg/dL, p=0.45), we found higher neutrophil count and NLR values in the low Vit D group when compared to normal Vit D group (low Vit D: 6049.8±3719.7 vs. normal Vit D: 3741.8±1704.1 ng/mL, p=0.02) and (low Vit D: 9.0±8.6 vs. normal Vit D: 4.2±4.0 ng/mL, p=0.03), respectively. Conclusion This data sharing-derived cases of COVID-19 in patients admitted at ICU showed that patients infected by COVID-19 had lower serum 25-hydroxy vitamin D and enhanced systemic inflammation when assessed by NLR values.

Comparison of the cardiovascular system, clinical condition, and laboratory results in COVID-19 patients with and without vitamin D insufficiency

“…Pimentel et al assessed 26 patients and showed that the mean CRP did not differ significantly between patients with low and normal vitamin D levels, while the mean lymphocyte count was higher in patients with low vitamin D levels [ 36 ]. Lakkireddy et al conducted a randomized clinical trial and showed that vitamin D therapy significantly reduced inflammatory factors in patients receiving vitamin D (CRP: 81 ± 66 vs. 16 ± 42; P < 0.0001, LDH: 369 ± 159 vs. 274 ± 115; P < 0.0001).…”

COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers

“…Most reports confirmed the association between vitamin D deficiency and COVID-19 infection in the general population both in Europe and Asia [48], as well as in hospitalized patients with COVID-19 [49,50], with highest prevalence in older patient groups with obesity [51,52]. Low 25OH vitamin D was reported in ICU patients with COVID-19 and associated with higher systemic inflammation markers in one study [53,54]. Another study further suggested that lower 25OH vitamin D may predict risk of death, particularly in older COVID-19 ICU patients [55].…”

Serum Vitamins A, D, and Zinc Levels in Children with Coronavirus Disease 2019 and Multisystem Inflammatory Syndrome in Children

“…A correlation has been reported between vitamin D3 deficiency and poor prognosis in critical COVID-19 infections in retrospective studies; however, other studies have reported no positive correlation. 25 26 27 28 Bayramoğlu et al, in their study evaluating the association between vitamin D3 levels, disease severity, and inflammation markers in an adolescent and pediatric patient group with COVID-19, reported lower vitamin D3 levels and higher levels of inflammation markers in the clinically more severe group. 29 Vitamin D3 levels have been found significantly lower in patients with COVID-19 than in healthy controls, and a negative correlation was reported between vitamin D3 and fever symptoms in a pediatric population.…”

“…30 Positive correlations have been identified between vitamin D3 deficiency and disease severity, hospital admission, high degree of systemic inflammation, intensive care admission, and mortality in studies of adult patient groups, with vitamin D3 support, reportedly decreasing the need for oxygen support. 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31…”