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Clinical Trial
. 2022 Jan 24:12:745713.
doi: 10.3389/fimmu.2021.745713. eCollection 2021.

Is There a Crucial Link Between Vitamin D Status and Inflammatory Response in Patients With COVID-19?

Federica Saponaro  1 , Maria Franzini  2 , Chukwuma Okoye  3 , Rachele Antognoli  3 , Beatrice Campi  1 , Marco Scalese  4 , Tommaso Neri  1 , Laura Carrozzi  1 , Fabio Monzani  3 , Riccardo Zucchi  1 , Alessandro Celi  1 , Aldo Paolicchi  2 , Alessandro Saba  1
Affiliations
Clinical Trial

Is There a Crucial Link Between Vitamin D Status and Inflammatory Response in Patients With COVID-19?

Federica Saponaro et al. Front Immunol. .

Abstract

Background: Hypovitaminosis D has been suggested to play a possible role in coronavirus disease 2019 (COVID-19) infection.

Methods: The aim of this study is to analyze the relationship between vitamin D status and a biochemical panel of inflammatory markers in a cohort of patients with COVID-19. A secondary endpoint was to evaluate the correlation between 25OHD levels and the severity of the disease. Ninety-three consecutive patients with COVID-19-related pneumonia were evaluated from March to May 2020 in two hospital units in Pisa, in whom biochemical inflammatory markers, 25OHD levels, P/F ratio at nadir during hospitalization, and complete clinical data were available.

Results: Sixty-five percent of patients presented hypovitaminosis D (25OHD ≤ 20 ng/ml) and showed significantly higher IL-6 [20.8 (10.9-45.6) vs. 12.9 (8.7-21.1) pg/ml, p = 0.02], CRP [10.7 (4.2-19.2) vs. 5.9 (1.6-8.1) mg/dl, p = 0.003], TNF-α [8.9 (6.0-14.8) vs. 4.4 (1.5-10.6) pg/ml, p = 0.01], D-dimer [0.53 (0.25-0.72) vs. 0.22 (0.17-0.35) mg/l, p = 0.002], and IL-10 [3.7 (1.8-6.9) vs. 2.3 (0.5-5.8) pg/ml, p = 0.03]. A significant inverse correlation was found between 25OHD and all these markers, even adjusted for age and sex. Hypovitaminosis D was prevalent in patients with severe ARDS, compared with the other groups (75% vs. 68% vs. 55%, p < 0.001), and 25OHD levels were lower in non-survivor patients.

Conclusions: The relationship between 25OHD levels and inflammatory markers suggests that vitamin D status needs to be taken into account in the management of these patients. If vitamin D is a marker of poor prognosis or a possible risk factor with beneficial effects from supplementation, this still needs to be elucidated.

Keywords: COVID-19; SARS-CoV-2; cytokine storm; hypovitaminosis D; vitamin D.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Difference in inflammatory markers [(A) IL-6, (B) CRP, (C) TNF-α, (D) D-dimer, (E) IL-10] between patients with 25OHD levels >20 ng/ml and those with 25OHD levels ≤20 ng/ml.
Figure 2
Figure 2
Correlation between inflammatory markers [(A) IL-6, (B) CRP, (C)TNF-alpha, (D) D-dimer, (E) IL-10] and 25OHD levels in patients with SARS-CoV-2.
Figure 3
Figure 3
Difference in proportion of patients with vitamin D insufficiency (25OHD levels ≤ 20 ng/ml) among patients with PaO2/FiO2 <200, 201–300, and ≥300 mmHg. ***p < 0.0001.
Figure 4
Figure 4
Difference in 25OHD levels between survivors and non-survivors patients. ***p < 0.0001.
See this image and copyright information in PMC

Comment in

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