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Vitamin D deficiency may predict seroconversion of COVID-19

 


The COVID-19 pandemic has led to intensive research on factors that worsen clinical phenotype, such as host, environmental, and genetic factors.Recent studies published on preprint servers medRxiv* In October 2020, the potential contribution of vitamin D deficiency to an increased risk of COVID-19 in a subset of UK healthcare professionals was reported.

Vitamin D protection mechanism

Vitamin D3 deficiency (VDD) causes immune dysregulation, which is manifested in changes in the morphology and function of immune cells, especially lymphocytes and monocytes, making the host particularly vulnerable to infection. It is very common in patients with bacterial sepsis and has been shown to increase the risk of acute respiratory distress syndrome (ARDS) in such patients.

ARDS is known to be a precursor to the death of ICU patients admitted with COVID-19. The severe illness itself promotes vitamin D deficiency. This is probably because it interferes with the normal metabolism of this vitamin.

Vitamin D is involved in the synthesis of potent steroid hormones that are involved in various cellular responses in many organs. This may explain how it is needed to resist and recover from inflammation, infections, lung disease, heart failure, and serious illnesses.

For one thing, it has been shown to promote the production of antibacterial compounds in the respiratory mucosa, reducing viral infections of the respiratory tract. It can also weaken the host’s response to SARS-CoV-2 after an infection has occurred. Currently, the prevalence of COVID-19 is among individuals with a black, Asian, and ethnic minority (BAME) background, even after adjusting for demographic and socioeconomic characteristics and the presence of chronic disease. Is overly high. However, there is also an increased risk of VDD in this group.

Again, the COVID-19 mortality risk group is proportional to distance from the equator and raises the question of whether sun exposure and VDD play a role in this pattern.

VDD and COVID-19 risk

The current study follows a study showing that shift workers in the non-UK healthcare sector are at higher risk of VDD than workers who work only during the day. Junior staff are also at higher risk than real staff and senior doctors. This study isolated VDD in UK NHS workers with demographic and occupational characteristics, self-reported symptoms, and actual COVID-19 and their prevalence. The purpose was to evaluate the prevalence. At normal vitamin D levels.

There were about 390 health care workers in this study. The median age was 41 years, with almost 75% being female and over 70% being Caucasian. Over 60% had other chronic illnesses. Vitamin D3 levels averaged about 56 nmol / l. Approximately 16% had VDD, averaging 22.0 nmol / l in the vitamin D-deficient group, compared to approximately 59 nmol / l in the non-deficient group.

Researchers have found that coming from a BAME background increases VDD odds by a factor of 9, while doubling the likelihood of being seropositive for COVID-19. Using this model, about 78% of VDD cases were predicted.

Serum D3 concentration in white and BAME staff

Serum D3 concentration in white and BAME staff

Low symptom correlation with VDD

Of the 386 patients who self-reported their symptoms, a third had a cough and the same proportion of diarrhea, but twice as many had a fever. Almost half of them had difficulty breathing and the same number had a sore throat. Over 70% reported body pain, nearly 90% reported malaise, and 45% reported abnormal taste or odor. Six patients with all normal vitamin D3 levels were asymptomatic.

About 82% of the VDD group had muscle pain-like symptoms, while the other groups had about 70%. Still, the symptoms themselves did not predict a decrease in vitamin D3 levels compared to the entire symptom-free group or sero-positive staff. Other symptoms, even those characteristic of COVID-19 respiratory infections such as fever and cough, showed no significant difference.

Patients with VDD were more likely to be seropositive in 72% vs. about 50%, but serolevels did not differ between seropositive and seronegative workers. This may be due to similar seropositive rates in Caucasians and BAME workers with and without VDD. However, in the latter group, men with VDD were more likely to be seropositive (94%) than men without VDD, at 52%.

VDD predicts COVID-19 seroconversion

The only important risk indicator for COVID-19 seropositive was VDD, which predicted more than half of all cases, regardless of gender, age, BMI, chronic disease, ethnicity, or occupation. This is the first time researchers have shown that seropositive COVID-19 indicates an increased risk of VDD.

This is consistent with previous observational studies showing that:COVID-19 positive tests were inversely proportional to vitamin D levels.. “

Implications

VDD increases the risk of a positive COVID-19 test by 45% and doubles the chance of needing hospitalization for the disease. The risk of COVID-19 is higher with VDD, or COVID-19 can induce VDD like other serious illnesses. The finding that BAME individuals are likely to have VDD is consistent with previous studies.

The researchers commented:BAME was not an independent risk factor for seroconversion in this cohort, but vitamin D-deficient BAME men may be the group at highest risk for COVID-19... “

All individuals in this cohort had mild COVID-19, but nevertheless, this indicates that BAME men are at increased risk of adverse consequences if they require ICU admission with COVID-19. is showing.

The author points out that:These data raise the question of whether vitamin D supplementation in people with vitamin D deficiency helps reduce the effects of SARS-Cov-2 in the event of infection... Some findings from recent trials seem to indicate that this is a direction worth following.

More research is needed to validate these findings in a wider range of diseases and other situations with diverse ethnic backgrounds and in larger cohorts.

However, given that BAME men are at increased risk of VDD and this is a factor in COVID-19 infection, cheap, readily available, and safe vitamin D supplementation seems worth a try. I will. To reduce risk, especially in clinical trials.

*Important Notices

medRxiv Publish preliminary scientific reports that should not be considered definitive as they are not peer-reviewed, guide clinical / health-related behaviors, and should not be treated as established information.

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