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Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19

Bennouar et al., Journal of the American College of Nutrition, doi:10.1080/07315724.2020.1856013

Jan 2021

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Vitamin D for COVID-19

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^*, now known with p < 0.00000000001 from 120 studies, recognized in 8 countries.

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Prospective study of 120 severe cases of COVID-19 in Algeria finding low vitamin D and low calcium both associated with increased mortality.

This is the 40th of 196 COVID-19 sufficiency studies for vitamin D, which collectively show higher levels reduce risk with p<0.0000000001 (1 in 11,637 vigintillion).

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risk of death, 85.5% lower, RR 0.14, p = 0.002, high D levels 4 of 30 (13.3%), low D levels 15 of 32 (46.9%), NNT 3.0, adjusted per study, inverted to make RR<1 favor high D levels, >30μg/l vs. <10μg/l, proportional Cox regression.

risk of death, 63.0% lower, RR 0.37, p = 0.10, high D levels 4 of 30 (13.3%), low D levels 14 of 35 (40.0%), NNT 3.7, adjusted per study, inverted to make RR<1 favor high D levels, >30μg/l vs. 10-19μg/l, proportional Cox regression.

risk of death, 23.1% lower, RR 0.77, p = 0.73, high D levels 4 of 30 (13.3%), low D levels 4 of 23 (17.4%), NNT 25, adjusted per study, inverted to make RR<1 favor high D levels, >30μg/l vs. 20-29μg/l, proportional Cox regression.

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Bennouar et al., 12 Jan 2021, prospective, Algeria, peer-reviewed, 5 authors.

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Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19

Salam Bennouar, Abdelghani Bachir Cherif, Amel Kessira, Djamel-Eddine Bennouar, Samia Abdi

Journal of the American College of Nutrition, doi:10.1080/07315724.2020.1856013

Background: The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality. Materials: This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve. Results: Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (p Log-Rank ¼ 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively. Hazard ratios were (HR ¼ 6.9, 95% CI [2.0-24.1], p ¼ 0.002 and HR ¼ 6.2, 95% CI [2.1-18.3], p ¼ 0.001) respectively. Conclusion: This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor shortterm prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.

Disclosure statement The authors have no conflicts of interest to declare. ORCID Salam Bennouar http://orcid.org/0000-0001-7414-6721

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