Covid-19 & Vitamin D : Santander & Heidelberg

Two more reports have been published that indicate the importance of low blood levels of vitamin D in determining death from Covid-19. 

It is vital to correct low blood levels of vitamin D.

Santander, Spain

Santander

Santander is a costal resort on the north coast of Spain, quite close to the border with France. It is a very pleasant resort and I have stayed there.

The study is snapshot observational and non-interventional. This means that low blood levels of vitamin D were not corrected.

It includes 216 hospital patients with Covid-19 infection and 197 community matched controls.

We can see (Figure 1) the blood levels of vitamin D in the Covid-19 hospital patients (blue) and the community controls who were well (green). It is clear that those with the very low blood levels (<10ng/ml) are mainly hospital patients with Covid-19. Correspondingly the higher blood levels (>20 and >30ng/ml) were found mainly in the healthy controls.  

Figure 1. Vitamin D levels in Covid-19 patients and controls

19 of the 216 patients were taking vitamin D before admission. These were analysed separately and details will be shown.

Hospital patients: mean Vitamin D level 13.8ng/ml 

Community controls: mean Vitamin D levels 20.9ng/ml

Figure 2. Vitamin D levels in Covid-19 patients and controls

A higher blood level of vitamin D appears to be of significant advantage, those with a lower level being ill and requiring admission to hospital (Figure 2).

The ideal blood level of vitamin D is greater than 30ng/ml (75nmol/L), as determined by several studies during the pandemic.  

It is perhaps surprising that blood levels of the community controls are so low, in a sunny place such as Santander.

47.2% of the community controls have blood levels less than the ideal 30ng/ml

82.2% of the hospital patients  have blood levels less than the ideal 30ng/ml

 

Hospital patients:

When admitted to hospital with Covid-19, there is a significant advantage of a higher vitamin D level in that it is associated with a lower need for transfer to ICU (Figure 3).

Vit D ≧ 20ng/ml  ICU required in 17.7%. 

Vit D < 20ng/ml  ICU required in 27.2%. 

Figure 3. Vitamin D levels and need for ICU transfer

Those with the higher blood levels of vitamin D, equal to or greater than 20ng/ml, had on average a shorter length of stay in hospital. (Figure 4)

Vitamin D ≧ 20ng/ml:  Days in hospital mean 8

Vitamin D < 20ng/ml:  Days in hospital mean 12

Figure 4. Vitamin D levels and length of stay in hospital

There was no difference in severity scores or deaths rates. 20 patients died, equally divided between groups  <10ng/ml and 10–20ng/ml.

Previous studies have indicated that a blood level of 30ng/ml is the threshold for high and low risk of death from Covid-19. It is unfortunate that the study did not divide the ≧ 20ng/ml group into two groups of 20–30 and >30ng/ml.

The effect of taking a vitamin D supplement.

There was a considerable benefit from taking a vitamin D supplement before the illness (Figure 5).

Covid-19 without Vitamin D supplement:

197 patients.

 50 (25.4%) needed ICU

 20 (10.4%) died

Covid-19 with Vit D supplement: 

19 patients

  1 (5.3%) needed ICU

  2 (10.5%) died.

Figure 5. Effect if vitamin D supplement on ICU transfer and death

This study shows more evidence that a good blood level of vitamin D and taking a supplement before the illness gives an advantage.

https://beta.ctvnews.ca/national/health/2020/10/27/1_5162396.html

https://www.sciencedaily.com/releases/2020/10/201027092216.htm

Heidelberg, Germany

Heidelberg Castle

This is a predictive non-interventional study of 185 hospital patients with Covid-10. 

Blood for vitamin D testing was taken on admission to hospital, but it was analysed only at the end of the study. This meant that the study was "blind", the investigators and the clinical staff having no knowledge of the blood levels of vitamin D of the patients. There was no vitamin D intervention and so the study design allowed predictive analysis.

185 patients in total.

 93 inpatients

 92 outpatients

The overall mean vitamin D level was 16.6 ng/ml (41.5nmol/L)

A blood level greater than 30ng/ml (75nmol/L) is regarded as ideal as judged by several other studies undertaken during the pandemic.

159 of the 185 patients (86%) had a blood level of vitamin D less than the ideal cut-off of 30ng/ml.

Figure 6. Blood levels of vitamin D in the Heidelberg study

Once again we see how common is vitamin D deficiency, but in this study there were no controls who were well. In patients with Covid-19 there is certainly an association with vitamin D deficiency, but more importantly blood levels of vitamin D predict the outcome.

The blood testing was taken at a relatively early stage in the illness, on admission to hospital.

The risks of ventilation and death are expressed as the hazard ratio. Ventilation and death rates of patients with low blood levels of vitamin D were compared to the ventilation and death rates of patients with blood levels >30ng/ml, who were given a standardised score of 1.

Hazard ratios for ICU ventilation:

Vitamin D >30ng  HR = 1.00 

Vitamin D <20ng  HR = 5.75 

Vitamin D <12ng  HR = 6.12

Hazard ratios for death:

Vitamin D >30ng  HR = 1.00

Vitamin D <20ng  HR = 11.27 

Vitamin D <12ng  HR = 14.73

Figure 7. Blood levels of vitamin D predicting need for ventilation and death

Having a blood vitamin D level of less than 12 ng/ml (30nmol/L) increased the risk of death by a factor 14.73. This is a reversible risk factor.

It is clear that in those with Covid-19 who require admission to hospital, a low blood level of vitamin D predicts a major risk of need for ventilation or death. I emphasise that this is a predictive study.

https://www.mdpi.com/2072-6643/12/9/2757

These two studies provide additional very strong evidence of the danger of a low blood level of vitamin D during the present pandemic of Covid-19.

I am of the opinion that predictive studies such as this must be brought to an end. With 18 positive published studies, we now have sufficient evidence of the benefits of vitamin D and the need to correct deficiency. 20 patients in the Heidelberg study died when they might not have done if they had been given appropriate vitamin D correction. We now need to minimise deaths by maximising defensive immunity.

Vitamin D deficiency and Covid-19 : its vital importance in a world pandemic

https://www.ypdbooks.com/2147-vitamin-d-deficiency-and-covid-19-its-central-role-in-a-world-pandemic-YPD02419.html

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