CLINICAL CORRELATION OF ACUTE PHASE REACTANTS AND VITAMIN D IN PATIENTS WITH CORONAVIRUS DISEASE IN THE NORTH-EASTERN PART OF INDIA
DOI:
https://doi.org/10.61751/ijmmr/2.2024.39Keywords:
COVID-19, observational, C-reactive protein, inflammation, associationAbstract
COVID-19 is associated with pre-existing co-morbid conditions and vitamin D insufficiency or deficiency as risk factors. Inflammatory biomarkers like acute phase reactants are widely used for monitoring treatment and outcome of the disease. A prospective and observational study was conducted with a purpose to analyse any clinical association of COVID-19 severity with levels of vitamin D, ferritin, lactate dehydrogenase, C-reactive protein, and D-dimer in 100 patients of COVID-19 at a zonal hospital in Tezpur, Assam, India in 2021. All relevant data including age, gender, or co-morbid conditions were retrieved from medical case sheets and laboratory test results. Serum samples of vitamin D and acute phase reactants were collected in COVID wards within 24 hours of admission. Prevalence of 71% of vitamin D deficiency was observed in the current study with mean ±2 SD of vitamin D of 16.6 ± 6.9 ng/mL in Group 1 and 17.1 ± 7.4 ng/mL in Group 2. No significant correlation of COVID-19 with deficiency of vitamin D was observed (p = 0.8107). Serum C-reactive protein levels varied substantially between Group 1 (24.46 ± 34.4 mg/L) and Group 2 (38.5 ± 32.5 mg/L) and were significantly associated with disease severity (p = 0.0397). Levels of ferritin, LDH, and D-dimer were also significantly elevated in Group 2 as compared to Group 1 (p < 0.05). It is therefore concluded that low vitamin D levels do not predict severity and outcomes in COVID-19. C-reactive protein, ferritin, lactate dehydrogenase and D-dimer levels are significantly associated and raised in patients with moderate to severe COVID-19
Received: 28.07.2024 | Revised: 06.10.2024 | Accepted: 26.11.2024
References
Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. New Engl J Med. 2020;382(8):727–33. DOI: 10.1056/NEJMoa2001017
Coronavirus disease (COVID-19) pandemic [Internet]. [cited 2024 June 8]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Singh S, Nimavat N, Kumar Singh A, Ahmad S, Sinha N. Prevalence of low level of vitamin D among COVID-19 patients and associated risk factors in India – a hospital-based study. Int J Gen Med. 2021;14:2523–31. DOI: 10.2147/IJGM.S309003
Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of vitamin D status and other clinical characteristics with COVID-19 test results. JAMA Netw Open. 2020;3(9):e2019722. DOI: 10.1001/jamanetworkopen.2020.19722
Sobczak M, Pawliczak R. Effect of vitamin D3 supplementation on severe COVID-19: A meta-analysis of randomized clinical trials. Nutrients. 2024;16(10):1402. DOI: 10.3390/nu16101402
Sanamandra P, Gada JV, Misra S, Barasara SA, Varthakavi PK, Bhagwat NM. Correlation between serum vitamin D3 levels and severity of COVID-19: Experience from a COVID-19-dedicated tertiary care hospital from Western India. Indian J Endocrinol Metab. 2023;27(2):170–6. DOI: 10.4103/ijem.ijem_383_22
Butler-Laporte G, Nakanishi T, Mooser V, Morrison DR, Abdullah T, Adeleye O, et al. Vitamin D and COVID-19 susceptibility and severity in the COVID-19 Host Genetics Initiative: A Mendelian randomization study. PLoS Med. 2021;18(6):e1003605. DOI: 10.1371/journal.pmed.1003605
Yastremska S, Krehkovska-Lepiavko O, Lokay B, Bushtynska O, Danchak S. The influence of chronic diseases on the manifestation of COVID-19 infection. Bull Med Biol Res. 2021;3(1):126–32. DOI: 10.11603/bmbr.2706-6290.2021.1.12098
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730–41. DOI: 10.1111/all.14238
Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M. Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect. 2020;81(4):647–79. DOI: 10.1016/j.jinf.2020.06.053
Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: A meta-analysis. Int J Infect Dis. 2020;96:467–74. DOI: 10.1016/j.ijid.2020.05.055
Luo HC, You CY, Lu SW, Fu YQ. Characteristics of coagulation alteration in patients with COVID-19. Ann Hematol. 2021;100(1):45–52. DOI: 10.1007/s00277-020-04305-x
The World Medical Association. Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects [Internet]. [cited 2024 June 8]. Available from: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507–13. DOI: 10.1016/S0140-6736(20)30211-7
Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271–80.e8. DOI: 10.1016/j.cell.2020.02.052
Ni W, Yang X, Yang D, Bao J, Li R, Xiao Y, et al. Role of angiotensin-converting enzyme 2 (ACE2) in COVID-19. Crit Care. 2020;24(1):422. DOI: 10.1186/s13054-020-03120-0
Kakodkar P, Kaka N, Baig MN. A comprehensive literature review on the clinical presentation and management of the pandemic coronavirus disease 2019 (COVID-19). Cureus. 2020;12(4):e7560. DOI: 10.7759/cureus.7560
de Lucena TMC, da Silva Santos AF, de Lima BR, de Albuquerque Borborema ME, de Azevêdo Silva J. Mechanism of inflammatory response in associated comorbidities in COVID-19. Diabetes Metab Syndr. 2020;14(4):597–600. DOI: 10.1016/j.dsx.2020.05.025
Ashique S, Gupta K, Gupta G, Mishra N, Singh SK, Wadhwa S, et al. Vitamin D: A prominent immunomodulator to prevent COVID-19 infection. Int J Rheum Dis. 2023;26(1):13–30. DOI: 10.1111/1756-185X.14477
Cutolo M, Paolino S, Smith V. Evidences for a protective role of vitamin D in COVID-19. RMD Open. 2020;6(3):e001454. DOI: 10.1136/rmdopen-2020-001454
Thangakunam B, Isaac B, John F, Sekar R, Samuel P, Shankar D, et al. Vitamin D deficiency is not related to adverse COVID-19 outcomes. Eur Respir J. 2022;60:840. DOI: 10.1183/13993003.congress-2022.840
Hastie CE, Pell JP, Sattar N. Vitamin D and COVID-19 infection and mortality in UK Biobank. Eur J Nutr. 2021;60:545–8. DOI: 10.1007/s00394-020-02372-4
AlKhafaji D, Al Argan R, Albaker W, Al Elq A, Al-Hariri M, AlSaid A, et al. The impact of vitamin D level on the severity and outcome of hospitalized patients with COVID-19 disease. Int J Gen Med. 2022;15:343–52. DOI: 10.2147/IJGM.S346169
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(6):1620. DOI: 10.3390/nu12061620
Biesalski HK. Vitamin D deficiency and co-morbidities in COVID-19 patients – a fatal relationship? NFS J. 2020;20:10–21. DOI: 10.1016/j.nfs.2020.06.001
Laird E, Rhodes J, Kenny RA. Vitamin D and inflammation: Potential implications for severity of COVID-19. Ir Med J. 2020;113(5):81.
Garg M, Al-Ani A, Mitchell H, Hendy P, Christensen B. Editorial: Low population mortality from COVID-19 in countries south of latitude 35 degrees north-supports vitamin D as a factor determining severity. Authors’ reply. Aliment Pharmacol Ther. 2020;51(12):1438–9. DOI: 10.1111/apt.15796
Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res. 2020;32(7):1195–8. DOI: 10.1007/s40520-020-01570-8
Mbata MK, Hunziker M, Makhdoomi A, Lüthi-Corridori G, Boesing M, Giezendanner S, et al. Is serum 25-hydroxyvitamin D level associated with severity of COVID-19? A retrospective study. J Clin Med. 2023;12(17):5520. DOI: 10.3390/jcm12175520
Chen J, Mei K, Xie L, Yuan P, Ma J, Yu P, et al. Low vitamin D levels do not aggravate COVID-19 risk or death, and vitamin D supplementation does not improve outcomes in hospitalized patients with COVID-19: A meta-analysis and GRADE assessment of cohort studies and RCTs. Nutr J. 2021;20:89. DOI: 10.1186/s12937-021-00744-y
Li Y, Tong CH, Bare LA, Devlin JJ. Assessment of the association of vitamin D level with SARS-CoV-2 seropositivity among working-age adults. JAMA Netw Open. 2021;4(5):e2111634. DOI: 10.1001/jamanetworkopen.2021.11634
Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014;144 Pt A:138–45. DOI: 10.1016/j.jsbmb.2013.11.003
Bennouar S, Cherif AB, Kessira A, Bennouar DE, Abdi S. Vitamin D deficiency and low serum calcium as predictors of poor prognosis in patients with severe COVID-19. J Am Coll Nutr. 2021;40(2):104–10. DOI: 10.1080/07315724.2020.1856013
Campi I, Gennari L, Merlotti D, Mingiano C, Frosali A, Giovanelli L, et al. Vitamin D and COVID-19 severity and related mortality: A prospective study in Italy. BMC Infect Dis. 2021;21(1):566. DOI: 10.1186/s12879-021-06281-7
Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with severe COVID-19. J Med Virol. 2020;92(7):791–6. DOI: 10.1002/jmv.25770
Henry BM, Aggarwal G, Wong J, Benoit S, Vikse J, Plebani M, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med. 2020;38(9):1722–6. DOI: 10.1016/j.ajem.2020.05.073
Long H, Nie L, Xiang X, Li H, Zhang X, Fu X, et al. D-dimer and prothrombin time are the significant indicators of severe COVID-19 and poor prognosis. Biomed Res Int. 2020;2020:6159720. DOI: 10.1155/2020/6159720
Taylor L. COVID-19: Vaccination reduces severity and duration of long COVID, study finds. BMJ (Clin Res Ed). 2023;380:491. DOI: 10.1136/bmj.p491
Aslam J, Rauf Ul Hassan M, Fatima Q, Bashir Hashmi H, Alshahrani MY, Alkhathami AG, et al. Association of disease severity and death outcome with vaccination status of admitted COVID-19 patients in delta period of SARS-COV-2 in mixed variety of vaccine background. Saudi J Biol Sci. 2022;29(7):103329. DOI: 10.1016/j.sjbs.2022.103329
The Moderna COVID-19 (mRNA-1273) vaccine: What you need to know [Internet]. [cited 2024 June 8]. Available from: https://www.who.int/news-room/feature-stories/detail/the-moderna-COVID-19-mrna-1273-vaccine-what-you-need-to-know
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