COVID 19

2. BY
Ahmed Abdel Hameed El-Sayed El-Banby
M.B.B.CH.,Tanta University
Association of plasma
25-hydroxyvitamin D levels with SARS-CoV-2
infection severity

8. Introduction
• From its origin in December 2019, the novel coronavirus disease,
COVID-19, caused by severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) virus, has spread rapidly throughout the world. The
disease primarily manifests as an acute respiratory illness, but can
affect multiple organs such as heart, digestive tract, and nervous
system. While the majority of cases has mild symptoms, some
progress to pneumonia, ARDS and potentially multi-organ failure and
shock. To date, it is not yet known why some patients develop more
severe symptoms.

9. Introduction
• In this COVID-19 emergency, given the complex pathophysiology of this
disease, information media sometimes based on insufficiently
supported data. One of these debated issues is the role of vitamin D in
modulating the severity of COVID-19, as this vitamin exerts well known
immuno-modulatory functions spanning from the innate to the adaptive
arms of the immune system and including the downregulation of
proinflammatory cytokines, such as interleukin-6 (IL-6) (Bouillon et al.,
2019).

10. Introduction
• A wealth of clinical and preclinical observations suggested that
insufficient vitamin D levels may favor viral infections, particularly in
the respiratory tract, as well as autoimmune disorders (Bouillon et al.,
2019; Quesada-Gomez et al., 2020).
• other studies demonstrated that vitamin D supplementation protects
against respiratory infections (Martineau et al., 2017; Jolliffe et al.,
2021).

11. Introduction
• There is an association between vitamin D deficiency and increased risk
of progression and death from viral infections such as HIV, due to
persistent immune activation, greater inflammation and activated
monocyte phenotypes (Jolliffe et al., 2021).

12. Introduction
• Based on all the above premises, it is not surprising that information
media, physicians and even health authorities had been debating about
the possibility that vitamin D replacement might represent an useful
intervention to strengthen the immune system and help in the fight
against COVID-19 (Mitchell, 2020).

14. To determine associations of plasma levels of vitamin D
with SARS-CoV-2 infection severity.

16. Study Design and Setting
 This case control analytic study conducted in Almaza Fever
Hospital .
120 Cases
90 patients
with confirmed
COVID-19
30 healthy
Control group

17. Eligibility criteria
INCLUSION CRITERIA:
• Adult patients (18-70 years)
• Confirmed COVID-19 viral infection by (RT-PCR) assay for case groups.
• No evidence of SARS-CoV-2 infection by (RT-PCR) at the time of 25(OH) vitamin
D measurement for control group.
EXCLUSION CRITERIA:
• Patients younger than 18 years
• Supplementation with over the counter formulations of vitamin D
• Subjects with a history of conditions that can lead to high serum calcium levels
such as sarcoidosis, tuberculosis and some lymphomas associated with
activated macrophages which increase the production of 1,25(OH) vitamin D.
• Inability to give informed consent.

18. Study Procedure
All Patients were subjected to:
- Clinical data:
including demographic,
comorbidities and clinical
presentation.
- Laboratory
investigations:
Circulating 25(OH)
vitamin D levels .
- Radiological
evaluation:
HRCT

19. Outcome measures
• Relationship of vitamin D
deficiency with COVID-19
severity, ICU admission and
mortality
Primary outcomes
• If vitamin D proved to minimize the
COVID-19 severity, it can be added as
a supplement to commercial oil and as
supplementation with over the
counter formulation of vitamin D.
Secondary outcome
parameters

21. Table (1): Describes demographic characters of studied groups
Factors
Control
(n=30)
Mild-COVID-19
(n=30)
Moderate-COVID-19
(n=30)
Severe-
COVID-19
(n=30)
P
Mean SD Mean SD Mean SD Mean SD
Age (Year) 44.93 16.39 25.9 7.49 51.2 18.13 64.13 5.98
<
0.001
BMI 23.33 3.617 22.3 2.51 26.067 4.156 23.68 3.26
<
0.001
N % N % N % N %
Male sex 22 73.33 29 96.67 24 80 21 70 0.02
Residence
Lower Egypt 3 10.0 18 60.0 23 76.7 22 73.3
<0.001
Upper Egypt 27 90.0 12 40.0 7 23.3 8 26.7

22. Table (1): Describes demographic characters of studied groups
Factors
Control
(n=30)
Mild-COVID-19
(n=30)
Moderate-COVID-
19
(n=30)
Severe-
COVID-19
(n=30)
P
Mean SD Mean SD Mean SD Mean SD
Current smoker 13 43.33 15 50 16 53.33 13 43.3 0.82
DM 8 26.67 2 6.67 11 36.67 19 63.3
<
0.001
HTN 11 36.67 1 3.33 11 36.67 17 56.7
<
0.001
Hyperlipidemia 10 33.33 5 16.67 19 63.33 16 53.3 <0.001

23. Table (2): Basic laboratory features in the studied groups
Factors
Control
(n=30)
Mild-COVID-19
(n=30)
Moderate-COVID-19
(n=30)
Severe-COVID-
19
(n=30)
P
Mean SD Mean SD Mean SD Mean SD
Hb 14.4 1.19 14.4 1.19 13.43 2.04 12.19 1.98 < 0.001
RBCs 4.97 0.52 4.97 0.52 4.93 0.88 4.26 0.77 < 0.001
TLC 6418 1638 6813 2077 11047 22682 9277 4579 0.37
Neutrophilis 5035 1954 5035 1954 6033 4988 7524 4267 0.02
Lymphocytes 1282 682 1282 682 5126 20519 1126 774 0.36
PLT 187.77 38.84 187.77 38.84 228.70 75.30 201.20 97.40 0.06

24. Table (2): Basic laboratory features in the studied groups
Factors
Control
(n=30)
Mild-COVID-19
(n=30)
Moderate-COVID-19
(n=30)
Severe-COVID-
19
(n=30)
P
Mean SD Mean SD Mean SD Mean SD
T.Bil 0.60 0.21 0.60 0.21 0.73 0.40 0.89 0.78 0.04
D.BIL 0.17 0.08 0.17 0.08 0.25 0.20 0.44 0.63 0.01
ALT 24 13.43 24 13.43 38 44.75 58.2 77.2 0.01
AST 24.63 8.15 24.63 8.15 38.37 32.2 75.5 77.7 < 0.001
Albumin 4.87 0.32 4.87 0.32 4.36 0.52 3.51 0.60 < 0.001
Creatinine 1.02 0.13 1.19 0.15 1.18 0.31 1.39 0.76 0.01
Urea 24.6 5.36 27.97 9.5 34.93 13.82 65.47 36.62 < 0.001
Uric acid 4.98 0.83 4.98 0.83 5.75 1.74 6.03 2.09 0.009

25. Table (3): Inflammatory marker levels in the studied groups
Factors
Control
(n=30)
Mild-COVID-19
(n=30)
Moderate-COVID-19
(n=30)
Severe-
COVID-19
(n=30)
P
Mean SD Mean SD Mean SD Mean SD
D-dimmer 0.21 0.13 0.21 0.13 0.70 1.10 1.37 2.10 < 0.001
Ferritin 77.07 36.52 201.30 203.30 338.60 423.50 953.00 765.0 < 0.001
IL6 2.89 1.04 7.57 4.17 40.70 154.60 186.80 458.1 0.01

26. Figure (1): Vitamin D level in the studied groups

27. Figure (2): Correlation of serum vitamin D with inflammatory markers
(D.dimmer, Ferritin and IL-6)

29. In Conclusion:
Our study contributes to a continually evolving body of evidence
that suggests a patient’s history of vitamin D deficiency is a
predictive risk factor associated with poorer COVID-19 clinical
disease course and mortality.
The use of historical results obtained before the COVID-19 pandemic
as part of a public health survey enabled us to suggest vitamin D
deficiency contributes to the causal pathway of COVID-19 mortality
risk and disease severity.

30. Our study warrants further studies investigating if and when vitamin
D supplementation among vitamin D deficient individuals in the
community impacts the outcome of an eventual COVID-19 episode.
Despite the numerous studies related to 25(OH)D and COVID-19, to
date, more well-designed RCTs are required to address further the
potential therapeutic applications of vitamin D for patients infected
with SARS-CoV-2.