Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
Department of Translational Research and New Technologies in Medicine, University of Pisa, Pisa, Italy.
Front Immunol. 2022 Jan 24;12:745713. doi: 10.3389/fimmu.2021.745713. eCollection 2021.
Hypovitaminosis D has been suggested to play a possible role in coronavirus disease 2019 (COVID-19) infection.
The aim of this study is to analyze the relationship between vitamin D status and a biochemical panel of inflammatory markers in a cohort of patients with COVID-19. A secondary endpoint was to evaluate the correlation between 25OHD levels and the severity of the disease. Ninety-three consecutive patients with COVID-19-related pneumonia were evaluated from March to May 2020 in two hospital units in Pisa, in whom biochemical inflammatory markers, 25OHD levels, P/F ratio at nadir during hospitalization, and complete clinical data were available.
Sixty-five percent of patients presented hypovitaminosis D (25OHD ≤ 20 ng/ml) and showed significantly higher IL-6 [20.8 (10.9-45.6) vs. 12.9 (8.7-21.1) pg/ml, = 0.02], CRP [10.7 (4.2-19.2) vs. 5.9 (1.6-8.1) mg/dl, = 0.003], TNF-α [8.9 (6.0-14.8) vs. 4.4 (1.5-10.6) pg/ml, = 0.01], D-dimer [0.53 (0.25-0.72) vs. 0.22 (0.17-0.35) mg/l, = 0.002], and IL-10 [3.7 (1.8-6.9) vs. 2.3 (0.5-5.8) pg/ml, = 0.03]. A significant inverse correlation was found between 25OHD and all these markers, even adjusted for age and sex. Hypovitaminosis D was prevalent in patients with severe ARDS, compared with the other groups (75% vs. 68% vs. 55%, < 0.001), and 25OHD levels were lower in non-survivor patients.
The relationship between 25OHD levels and inflammatory markers suggests that vitamin D status needs to be taken into account in the management of these patients. If vitamin D is a marker of poor prognosis or a possible risk factor with beneficial effects from supplementation, this still needs to be elucidated.
维生素 D 缺乏症被认为可能在 2019 年冠状病毒病（COVID-19）感染中发挥作用。
本研究旨在分析维生素 D 状态与 COVID-19 患者队列中炎症标志物生化谱之间的关系。次要终点是评估 25OHD 水平与疾病严重程度之间的相关性。2020 年 3 月至 5 月，在比萨的两个医院病房评估了 93 例 COVID-19 相关肺炎连续患者，其中可获得生化炎症标志物、25OHD 水平、住院期间最低时的 P/F 比值以及完整的临床数据。
65%的患者存在维生素 D 缺乏症（25OHD≤20ng/ml），并显示出明显更高的白细胞介素 6[20.8（10.9-45.6）比 12.9（8.7-21.1）pg/ml， = 0.02]、C 反应蛋白[10.7（4.2-19.2）比 5.9（1.6-8.1）mg/dl， = 0.003]、肿瘤坏死因子-α[8.9（6.0-14.8）比 4.4（1.5-10.6）pg/ml， = 0.01]、D-二聚体[0.53（0.25-0.72）比 0.22（0.17-0.35）mg/l， = 0.002]和白细胞介素 10[3.7（1.8-6.9）比 2.3（0.5-5.8）pg/ml， = 0.03]。即使调整年龄和性别，25OHD 与所有这些标志物之间也存在显著的负相关。与其他组相比，维生素 D 缺乏症在严重急性呼吸窘迫综合征患者中更为普遍（75%比 68%比 55%， < 0.001），且非幸存者患者的 25OHD 水平较低。
25OHD 水平与炎症标志物之间的关系表明，在这些患者的管理中需要考虑维生素 D 状态。如果维生素 D 是预后不良的标志物或补充可能有有益效果的潜在危险因素，这仍需阐明。
