Does Vitamin D Supplementation Reduce Cytokine Storm and Mortality in Geriatric Intensive Care Patients Diagnosed with COVID-19

Year 2022, Volume: 12 Issue: 2, 233 - 237, 15.03.2022

Yeliz Bilir , Akın Bilir Ayten Saracoğlu , Fulya Çiyiltepe , Elif Bombacı , Kemal Tolga Saraçoğlu Recep Demirhan

https://doi.org/10.16899/jcm.990057

Cited By: 1

Abstract

Introduction: Coronavirus disease progresses from an asymptomatic stage to a fatal stage characterized by a cytokine storm. Therefore, treatment should focus on enhancing the patients’immune function and preventing cytokine release syndrome. Vitamin-D deficiency is one of the factors triggering cytokine release syndrome. The present study aimed to emphasize the therapeutic effect of vitamin-D supplementation and its potential importance in reducing the disease severity in older adults in the intensive care unit after COVID-19 diagnosis.
Materials and Method: The data of 80 patients aged ≥ 65 years who followed up in intensive care clinic. The inflammatory parameters and clinical course of 40 patients whose serum 25-hydroxyvitamin-D level was below 30ng/ml and who received vitamin-D supplementation (case-group) were recorded on the fifth and tenth days of follow-upand compared with those of the other 40 patients who were hospitalized during the initial period of the pandemic and who did not receive vitamin-D supplementation (control-group).
Results: Cytokine release syndrome, has developed in the case group rarely. On the 10.day, levels of the inflammatory markers C-reactive protein, procalcitonin, D-dimer, ferritin, interleukin-6, and lactate dehydrogenase were significantly lower and the lymphocyte count was significantly higher in the case group than in the control group. On the 5.day, the interleukin-6 level was significantly lower in the case group. Weaning was performed in nine and four patients in the case and control groups, respectively. There was no significant difference in mortality rates between the groups.
Conclusion: Vitamin-D supplementation can help reduce cytokine response. Recommended prophylactically or therapeutically at all stages of coronavirus disease.

Keywords

ELDERLY PATIENTS, COVID-19, Cytokine Release Syndrome, IntensiveCareUnits, Vitamin D

Covıd-19 tanılı Geriatrik Yoğun Bakım Hastalarında D Vitamini Desteği Sitokin Fırtınasını ve Mortaliteyi Azaltır mı?

Abstract

Amaç: COVID-19 enfeksiyonunda klinik; asemptomatik durumdan, sitokin fırtınası ile karakterize ölümcül tabloya kadar değişen geniş bir yelpazede seyretmektedir. Bu nedenle tedaviler hastaların bağışıklık fonksiyonunun arttırılmasına ve sitokin fırtınasının engellenmesine odaklanmalıdır. D vitamini eksikliği, şiddetin belirleyicilerinden biri olarak kabul edilmiştir. Bu makalede, tanı aldıktan sonra yoğun bakımda takibe başlanan geriatrik hasta grubunda D vitamini desteğinin terapötik etkisi ve hastalık şiddeti üzerine potansiyel önemini vurgulamak istiyoruz.
Materyal ve Metod: Mart ve Haziran 2021 tarihleri arasında Yoğun Bakım Kliniğimizde takip edilen COVID-19 tanısı almış 65 yaş ve üstü 80 hastanın verileri retrospektif olarak incelendi. Serum 25 (OH) D<30ng / mL olan ve Dvitamini desteği başlanan 40 hastanın, COVID-19 tanısı aldıktan sonra 5. ve 10. günlerdeki enflamatuar parametreleri ve klinik seyri kaydedilerek, D vitamini desteği başlanmamış olan kontrol grubunun verileri ile karşılaştırıldı.
Bulgular: 80 hastadan40’ı (%50) erkek ve 40’ı (% 50) kadın idi. Hastaların ortalama yaşı 72 ± 10.8 yıldı.10. gün ölçümlerinde enflamatuar belirteçlerden CRP, Prokalsitonin, D-Dimer, Ferritin, IL-6, LDH değerlerinin kontrol grubuna göre anlamlı düşük seyrettiği (P<0.05) ve lenfosit değerininanlamlı yüksek seyrettiği gözlendi (p=0.008) (Tablo 2).Beşinci gün ölçümlerinde IL-6 düzeyi vaka grubunda anlamlı olarak daha düşüktü. Vaka ve kontrol grubunda sırasıyla 9 ve 4 hastada weaning uygulandı. Gruplar arasında weaning ve mortalite oranları açısından istatistiklsel olarak anlamlı bir fark görülmedi.
Sonuç:D vitamini tedavisinin, özellikle hipovitaminoz D'nin sık görüldüğü geriatrik hastalarda hastalık şiddetini ve sitokin yanıtını azaltmada katkı sağlayabileceği makul görünmektedir. D vitamini takviyesi, coronavirüs hastalığının tüm aşamalarında profilaktik veya terapötik olarak önerilir.

Keywords

Geriatrik Popülasyon, COVID-19, Sitokin Fırtınası, Yoğun Bakım Üniteleri, D Vitamini

References

• 1. World HealthOrganization. (2020). Coronavirusdisease 2019 (COVID-19): situationreport, 82.
• 2. EpidemiologyWorkingGroupforNCIPEpidemicResponse, Chinese Center forDisease Control and Prevention. ZhonghuaLiuXing Bing XueZaZhi 2020;41(2):145-51 (PMID: 32064853)
• 3. Lu D, Zhang J, Ma C, et al. Link betweencommunity-acquired pneumoniaand vitamin D levels in olderpatients. Z GerontolGeriatr 2018;51(4):435-9 (PMID: 28477055)
• 4. BeardJA, Bearden A, Striker R. Vitamin D andthe anti-viral state. J ClinVirol 2011 50(3):194-200 (PMID: 21242105)
• 5. Greiller CL, Martineau AR. Modulation of theimmuneresponsetorespiratoryvirusesby vitamin D. Nutrients 2015;7(6):4240-70 (PMID: 26035247)
• 6. Teymoori-Rad M, Shokri F, Salimi V, et al. The inter play between vitamin D and viral infections. RevMedVirol 2019;29(2):e2032 (PMID: 30614127)
• 7. Trovas G, Tournis S. Vitamin D and COVID-19. Hormones (Athens) 2021;20:207-8. (PMID: 32666357)
• 8. Vásárhelyi B, Sátori A, Olajos F, et al. Low vitamin D level samong patients at Semmelweis University: retrospective analysis during a one-year period. OrvHetil 2011; 52(32):1272-7 (PMID: 21803724)
• 9. Conti P, Ronconi G, Caraffa A, et al. Induction of pro-inflammatorycytokines (IL-1 andIL-6) and lung inflammation by Coronavirus-19 (COVID-19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents 2020;34(2):327-31 (PMID: 32171193)
• 10. Ardizzone S, Cassinotti A, Trabattoni D, et al. Immunomodulatoryeffects of 1,25-dihydroxyvitamin D3 on TH1/TH2 cytokines in inflammatory bowel disease: an in vitro study. Int J Immunopathol Pharmacol 2009;22(1):63-71 (PMID: 19309553)
• 11. Zabetakis I, Lordan R, Norton C, et al. COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation. Nutrients 2020;12(5):1466 (PMID: 32438620)
• 12. Yan R, Zhang Y, Li Y, et al. Structural basis for there cognition of SARS-CoV-2 by full-length human ACE2. Science 2020;367(6485):1444-8 (PMID: 32132184)
• 13. Gheblawi M, Wang K, Viveiros A, et al. Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptorand Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2. CircRes 2020;126(10):1456-74 (PMID: 32264791)
• 14. LiYC, Qiao G, Uskokovic M, et al. Vitamin D: a negative endocrine regulator of the renin-angiotensinsystemandbloodpressure. J Steroid BiochemMolBiol. 2004;(1-5):387-92. (PMID: 15225806)
• 15. Hanff TC, Harhay MO, Brown TS, Cohen JB, Mohareb AM. Is There an Association Between COVID-19 Mortality and the Renin-Angiotensin System? A Call for Epidemiologic Investigations. Clin Infect Dis. 2020;71(15):870-4 (PMID: 32215613)
• 16. Binkley N, Ramamurthy R, Krueger D. Low vitamin D status: definition, prevalence, consequences, andcorrection. Endocrinol Metab Clin North Am. 2010;39(2):287-301 (PMID: 20511052)
• 17. Thomas MK, Lloyd-Jones DM, ThadhaniRI, et al. Hypovitaminosis D in medicalinpatients. N Engl J Med. 1998;338(12):777-83 (PMID: 9504937)
• 18. ALIPIO, Mark. Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19). Available at SSRN 3571484, 2020.
• 19. HribarCA, CobboldPH, ChurchFC. Potential Role of Vitamin D in the Elderly to Resist COVID-19 and to Slow Progression of Parkinson's Disease. Brain Sci. 2020;10(5):284. (PMID: 32397275)
• 20. Martineau AR, Jolliffe DA, HooperRL, et al. Vitamin D supplementation to preventacuterespiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017;356:i6583 (PMID: 28202713)
• 21. Boucher BJ. Theproblems of vitamin d insufficiency in olderpeople. Aging Dis. 2012;3(4):313-29 (PMID: 23185713)
• 22. Baktash V, Hosack T, Patel N, et al. Vitamin D status and outcomes for hospitalised older patients with COVID-19. Postgrad Med J. 2021;97(1149):442-7.(PMID: 32855214)
• 23. Grant WB, Baggerly CA, Lahore H. Reply: "Vitamin D Supplementation in Influenza and COVID-19 Infections. Comment on: Evidence That Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths Nutrients 2020, 12(4), 988". Nutrients 2020;12(6):16-20 (PMID: 32492787)
• 24. Rhodes JM, Subramanian S, Laird E, et al. Editorial: low population mortality from COVID-19 in countriessouth of latitude 35 degrees North supports vitamin D as a factor determining severity. Aliment Pharmacol Ther.2020;51(12):1434-7 (PMID:32311755)
• 25. Panarese A, Shahini E. Letter: Covid-19, and vitamin D. Aliment Pharmacol Ther. 2020;51(10):993-5 (PMID: 32281109)
• 26. Autier P, Mullie P, Macacu A, et al. Effect of vitamin D supplementation on non-skeletaldisorders: a systematic review of meta-analyses and randomised trials. Lancet Diabetes Endocrinol 2017;5(12):986-1004 (PMID: 29102433)
• 27. Wang R, De Gruttola V, Lei Q, et al. The vitamin D for COVID-19 (VIVID) trial: A pragmatic cluster-randomized design. Contemp Clin Trials. 2021;100:106-76 ( PMID: 33045402)