Vitamin D is essential for bone and mineral metabolism. Vitamin D has a role in regulating innate and adaptive immune responses, as vitamin D receptors are present on immune cells such as B cells, T cells, and antigen-presenting cells, and these cells can synthesize active vitamin D metabolites. There is also a possibility.1 These immunomodulatory effects of vitamin D are thought to have the potential to prevent SARS-CoV-2 infection and reduce the severity of coronavirus disease (COVID-19).
Vitamin D deficiency (defined as serum concentrations of 25-hydroxyvitamin D ≤ 20 ng/mL) is common in the United States, especially among people who identify as Hispanic or non-Hispanic black.2 These groups account for the majority of coronavirus disease (COVID-19) cases in the United States.3 Vitamin D deficiency is also common in older patients and in those with obesity and hypertension. These factors are associated with worse outcomes for patients infected with COVID-19.Four High levels of vitamin D can cause hypercalcemia and nephrocalcinosis.Five
recommendation
- There is insufficient evidence for the COVID-19 Treatment Guidelines Committee (Panel) to recommend for or against the use of vitamin D in the prevention or treatment of COVID-19.
rationale
Results of several cohort studies, clinical trials, and meta-analyses on the use of vitamin D in the prevention or treatment of coronavirus disease (COVID-19) have been published in peer-reviewed journals or have been published in manuscript prior to peer review. It is published as. However, most of these studies had significant limitations, such as small sample size and lack of randomization or blinding. Additionally, these studies used different doses and formulations of vitamin D, enrolled participants with different COVID-19 severities, included different concomitant medications, and measured different study outcomes. . All these factors make it difficult to compare results across studies. The studies summarized below are those that most influenced the panel’s recommendations.
Multiple observational cohort studies suggest that people with low vitamin D levels are at increased risk of SARS-CoV-2 infection and have worse clinical outcomes (e.g., higher mortality) after infection, but vitamin There is clear evidence that D supplementation protects against infection or improves outcome. The number of patients infected with the new coronavirus is still insufficient.6,7
Clinical data on vitamin D for prevention
In a double-blind trial conducted in four hospitals in Mexico, front-line health care workers were randomly assigned to receive vitamin D.3 4,000 IU or placebo for 30 days.8 Participants were enrolled before a COVID-19 vaccine was available. More than one third of enrolled participants dropped out before study completion. Of the 192 participants who completed follow-up, 6.4% of participants were taking vitamin D.3 In the treatment group, 24.5% developed SARS-CoV-2 infection, and in the placebo treatment group, 24.5% developed SARS-CoV-2 infection (relative risk, 0.22; 95% CI, 0.08 to 0.59). At baseline, approximately 67% of participants had vitamin D deficiency, but this was not found to be an independent predictor of SARS-CoV-2 infection. Although the frequency of SARS-CoV-2 infections was significantly higher in the placebo group, it is unclear how these results translate to the use of vitamin D in vaccinated healthcare workers.
Clinical data on vitamin D for treatment
In a double-blind study conducted between June and October 2020 in two locations in Brazil, 240 hospitalized patients with moderate to severe COVID-19 infections were invited to receive a single dose of vitamin D. randomly assigned.3 200,000 IU or placebo.9 Patients have a positive polymerase chain reaction (PCR) result for SARS-CoV-2 or compatible computed tomography scan findings, and a respiratory rate greater than 24 breaths/min or oxygen saturation less than 93%. were considered to have moderate to severe coronavirus disease (COVID-19). in the air of the room. The primary outcome was length of hospital stay. This study found no significant difference in median length of hospital stay between those taking vitamin D and those taking vitamin D.3 group (7.0 days, IQR 4.0 to 10.0 days) and placebo group (7.0 days, IQR 5.0 to 13.0 days, log rank) P = 0.59). No significant differences were observed between the groups in the proportion of patients admitted to the intensive care unit (ICU), need for mechanical ventilation, or mortality. There were no significant safety concerns.
A randomized, double-blind, placebo-controlled study conducted in Argentina included adults with COVID-19 infection who had been hospitalized within the past 24 hours, had an oxygen saturation of 90% or higher on room air, and had risk factors for infection. A total of 218 patients participated. disease progression.Ten Patients were randomized to receive a single oral dose of vitamin D.3 500,000 IU or placebo. The primary outcome was change in Respiratory Sepsis-Related Organ Failure Assessment (rSOFA) score between baseline and the highest value recorded by day 7. There was no significant difference between the two groups for this outcome, with a median change of 0. Both arms(P = 0.925). There were also no significant differences between the two groups in median length of stay, number of patients admitted to the ICU, and in-hospital mortality.
A randomized, open-label study conducted in France compared the effects of high doses of vitamin D3 (400,000 IU) to standard dose of vitamin D3 (50,000 IU) pertained to the mortality rate of 254 patients who were hospitalized or living in a nursing home near the study hospital site.11 Patients are 65 years of age or older, have been diagnosed with SARS-CoV-2 infection within the past 3 days, and have at least one risk factor for disease progression (i.e., 75 years of age or older, hypoxemia). Mortality rates at 14 days were significantly different between the two groups, with 7 (6%) deaths in the high-dose group and 14 (11%) deaths in the standard-dose group (adjusted HR 0.33; 95% CI, 0.12-0.86; P = 0.02). However, mortality at 28 days was not significantly different between the groups (adjusted HR 0.70, 95% CI, 0.36-1.36, 0.36-1.36). P = 0.29).
In an open-label pilot study, 50 hospitalized adults in New York with PCR-confirmed SARS-CoV-2 infection were randomly assigned to receive 0.5 μg of calcitriol daily for 14 days or no treatment. .12 Calcitriol is the active metabolite of cholecalciferol or vitamin D.3 It is often used to treat parathyroid disease. This study evaluated changes in oxygen saturation between admission and discharge of patients. An additional outcome was length of hospital stay. Death; requiring endotracheal intubation, ICU admission, or readmission within 30 days. Oxygen saturation was calculated using the ratio of peripheral oxygen saturation (measured by pulse oximetry) to the fraction of inspired oxygen (SpO).2/FiO2) as a proxy for the ratio of arterial oxygen partial pressure to inspired oxygen partial pressure (PaO)2/FiO2). Between admission and discharge, this ratio increased by an average of 13.2 (SD 127.7) in patients who received no treatment, and by 91.04 (SD 119.08; SD 119.08) in patients who received calcitriol. I did. P= 0.0305), meaning improved oxygenation.12 There were no differences between the two groups in length of stay, mortality, need for ICU admission or readmission.
