J Med Virol. 2021 Jul 17. doi: 10.1002/jmv.27215. Online ahead of print.
AIMS: We have previously demonstrated that vitamin D deficiency might be associated with worse outcomes in hospitalised Covid-19 patients. The aim of our study was to explore this relationship with dexamethasone therapy.
METHODS: We prospectively studied two cohorts of hospitalised Covid-19 patients between March and April and between September and December 2020 (n=192). Patients were tested for serum 25-hydroxyvitamin D (25-OH-D) levels during admission. The first cohort not treated with dexamethasone (n=107) were divided into vitamin D deficient (25-OH-D ≤30nmol/L) (n=47) and replete subgroups (25-OH-D >30nmol/L) (n=60). The second cohort treated with dexamethasone (n=85) was similarly divided into deficient (25-OH-D ≤30nmol/L) (n=27) and replete subgroups (25-OH-D >30nmol/L) (n=58). Primary outcome was in-hospital mortality and secondary outcomes were elevation in markers of cytokine storm and ventilatory requirement.
RESULTS: No mortality difference was identified between cohorts and subgroups. The "no dexamethasone" cohort 25-OH-D deplete subgroup recorded significantly higher peak D-Dimer levels (1874ugFEU/L vs 1233ugFEU/L) (p value = 0.0309), CRP (177 vs 107.5) (p=0.0055) and ventilatory support requirement (25.5% vs 6.67%) (p value = 0.007) compared to the replete subgroup. Among the 25-OH-D deplete subgroup higher peak neutrophil counts, peak CRP, peak LDH, peak ferritin and lower trough lymphocyte counts were observed, without statistical significance. In the "dexamethasone" cohort, there was no apparent association between 25-OH-D deficiency and markers of cytokine storm or ventilatory requirement.
CONCLUSION: Vitamin D deficiency is associated with elevated markers of cytokine storm and higher ventilatory requirements in hospitalised Covid-19 patients. Dexamethasone treatment appears to mitigate adverse effects of vitamin D deficiency. This article is protected by copyright. All rights reserved.