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

Introduction: Vitamin D is an important micronutrient having crucial role in calcium and phosphate homeostasis but there is emerging evidence to suggest its role in prevention of infectious, inflammatory and neoplastic diseases. The vitamin D insufficiency/deficiency is a widely recognized problem among children in developed as well as developing countries.Objective: To find out the prevalence of vitamin D deficiency/insufficiency among children aged 2 months to 13 yrs and its correlation with serum calcium, phosphate and demographic factors.Methodology: Prospective, cross sectional, hospital based study conducted at Birat Medical College Teaching Hospital for a period of one year among children presented to pediatric OPD in whom pediatrician had a suspicion of Vitamin D Insufficiency /Deficiency. Venous blood Samples were taken for the estimation of 25(OH) Vitamin D, Calcium and Phosphate. Statistical analysis was done using SPSS software version 16. Results Among 174 children aged 2 months to 13 years, the prevalence of vitamin D insufficiency at the cutoff of <30ng/ml was 82.75% where as no cases of vitamin D deficiency was noted at cut off level of < 10 ng/ml. Children residing in urban area, samples taken in the winter season had higher prevalence of vitamin D insufficiency (p value <0.05). Serum calcium and phosphate level were found positively correlated with Vitamin D level (p<.05). However the relationship was very strong between Vitamin D and Calcium (r=0.402, p-value <0.001) and weak positive correlation was noted with phosphate(r=0.155, p value <0.05).Conclusion: There is very high prevalence of Vitamin D insufficiency among children. The vitamin D insufficiency was significantly higher in winter season as compared to summer. Children living in the urban area are more prone to Vitamin D insufficiency. Moderately strong positive correlation was observed between Vitamin D level and calcium but weak correlation existed with phosphate. BJHS 2018;3(1)5 : 381-384

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VITAMIN D DEFICIENCY AND PARATOHOMMONIUM INCREASE IN LATE POSTOPERATIVE GASTRIC BYPASS IN ROUX-EN-Y

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1407 ◽

2018 ◽

Vol 31 (4) ◽

Cited By ~ 2

Author(s):

Daniela Vicinansa MÔNACO-FERREIRA ◽

Vânia Aparecida LEANDRO-MERHI ◽

Nilton César ARANHA ◽

Andre BRANDALISE ◽

Nelson Ary BRANDALISE

Keyword(s):

Vitamin D ◽

Gastric Bypass ◽

Secondary Hyperparathyroidism ◽

Vitamin D Deficiency ◽

Serum Calcium ◽

Calcium Metabolism ◽

Calcium Deficiency ◽

Ionized Calcium ◽

Nutritional Deficiencies ◽

Biochemical Tests

ABSTRACT Background : Roux-en-Y gastric bypass patients can experience changes in calcium metabolism and hyperparathyroidism secondary to vitamin D deficiency. Aim : To evaluate nutritional deficiencies related to the calcium metabolism of patients undergoing gastric bypass with a 10-year follow-up. Method : This is a longitudinal retrospective study of patients submitted to Roux-en-Y gastric bypass at a multidisciplinary clinic located in the Brazilian southeast region. The study investigated the results of the following biochemical tests: serum calcium, ionized calcium, vitamin D, and parathormone (PTH). The generalized estimating equations (GEE) determined the nutritional deficiencies using a significance level of 5%. Results : Among the patients who finished the study (120 months), 82.86% (n=29) had vitamin D deficiency, and 41.94% (n=13) had high PTH. Postoperative time had a significant effect on PTH (p=0.0059). The percentages of patients with vitamin D, serum calcium, and ionized calcium deficiencies did not change significantly over time. Conclusion : One of the outcomes was vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of monitoring the bone metabolism of patients submitted to Roux-en-Y gastric bypass. HEADINGS: Calcium deficiency. Vitamin D deficiency. Secondary hyperparathyroidism.

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Preoperative Low Serum Calcium Levels Predict Poor Prognosis for Patients with Esophageal Cancer

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.oa.21-00167 ◽

2021 ◽

Author(s):

Fumiaki Shiratori ◽

Takashi Suzuki ◽

Satoshi Yajima ◽

Yoko Oshima ◽

Tatsuki Nanami ◽

...

Keyword(s):

Esophageal Cancer ◽

Serum Calcium ◽

Poor Prognosis ◽

Low Serum

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Prevalence and Correction of 25(OH) Vitamin D Deficiency in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080502500411 ◽

2005 ◽

Vol 25 (4) ◽

pp. 362-366 ◽

Cited By ~ 61

Author(s):

Nirav Shah ◽

Judith Bernardini ◽

Beth Piraino

Keyword(s):

Vitamin D ◽

Peritoneal Dialysis ◽

Calcium Phosphate ◽

Vitamin D Deficiency ◽

Muscle Weakness ◽

Serum Calcium ◽

Bone Pain ◽

Vitamin D Levels ◽

Before And After ◽

25 Oh Vitamin D

Background Peritoneal dialysis (PD) patients are at risk for 25(OH) vitamin D deficiency due to effluent loss in addition to traditional risk factors. Objectives To measure 25(OH) vitamin D deficiency in prevalent PD patients, to evaluate a replacement dose, and to determine the effects of correction. Methods 25(OH) vitamin D levels were drawn on prevalent PD patients. Patients deficient in 25(OH) vitamin D were given ergocalciferol, 50 000 IU orally once per week for 4 weeks. Patients scored muscle weakness, bone pain, and fatigue on a scale of 0 (none) to 5 (severe). Serum calcium, phosphate, parathyroid hormone (PTH), and 25(OH) vitamin D, and 1,25(OH)2 vitamin D levels were obtained before and after treatment. Results 25(OH) vitamin D levels were measured in 29 PD patients. Deficiency (<15 ng/mL) was found in 28/29 (97%); 25/29 (86%) had undetectable levels (<7 ng/mL). One course of ergocalciferol corrected the deficiency in all but 1 patient, who required a second course. Scores for muscle weakness and bone pain fell from pre- to posttreatment ( p < 0.001). 1,25(OH)2 vitamin D levels rose post ergocalciferol (from 20 to 26 pg/mL, n = 20, p = 0.09). Serum calcium, phosphate, and PTH levels did not change with ergocalciferol. Conclusions Most PD patients had marked 25(OH) vitamin D deficiency, which was readily and safely corrected with one course of 50000 IU ergocalciferol, having no effect on serum calcium, phosphorus, or PTH, but complaints of muscle weakness and bone pain decreased. A prospective, placebo-controlled double-blinded study is needed to determine whether replacement of 25(OH) vitamin D is beneficial in PD patients.

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The Effect of High-Dose Postpartum Maternal Vitamin D Supplementation Alone Compared with Maternal Plus Infant Vitamin D Supplementation in Breastfeeding Infants in a High-Risk Population. A Randomized Controlled Trial

Nutrients ◽

10.3390/nu11071632 ◽

2019 ◽

Vol 11 (7) ◽

pp. 1632 ◽

Cited By ~ 12

Author(s):

Adekunle Dawodu ◽

Khalil M. Salameh ◽

Najah S. Al-Janahi ◽

Abdulbari Bener ◽

Naser Elkum

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Serum Calcium ◽

Vitamin D3 ◽

Controlled Trial ◽

Vitamin D Supplementation ◽

Urine Calcium ◽

Randomized Controlled ◽

High Prevalence ◽

Maternal Supplementation

In view of continuing reports of high prevalence of severe vitamin D deficiency and low rate of infant vitamin D supplementation, an alternative strategy for prevention of vitamin D deficiency in infants warrants further study. The aim of this randomized controlled trial among 95 exclusively breastfeeding mother–infant pairs with high prevalence of vitamin D deficiency was to compare the effect of six-month post-partum vitamin D3 maternal supplementation of 6000 IU/day alone with maternal supplementation of 600 IU/day plus infant supplementation of 400 IU/day on the vitamin D status of breastfeeding infants in Doha, Qatar. Serum calcium, parathyroid hormone, maternal urine calcium/creatinine ratio and breast milk vitamin D content were measured. At baseline, the mean serum 25-hydroxyvitamin D (25(OH)D) of mothers on 6000 IU and 600 IU (35.1 vs. 35.7 nmol/L) and in their infants (31.9 vs. 29.6) respectively were low but similar. At the end of the six month supplementation, mothers on 6000 IU achieved higher serum 25(OH)D mean ± SD of 98 ± 35 nmol/L than 52 ± 20 nmol/L in mothers on 600 IU (p < 0.0001). Of mothers on 6000 IU, 96% achieved adequate serum 25(OH)D (≥50 nmol/L) compared with 52%in mothers on 600 IU (p < 0.0001). Infants of mothers on 600 IU and also supplemented with 400 IU vitamin D3 had slightly higher serum 25(OH)D than infants of mothers on 6000 IU alone (109 vs. 92 nmol/L, p = 0.03); however, similar percentage of infants in both groups achieved adequate serum 25(OH)D ≥50 nmol/L (91% vs. 89%, p = 0.75). Mothers on 6000 IU vitamin D3/day also had higher human milk vitamin D content. Safety measurements, including serum calcium and urine calcium/creatinine ratios in the mother and serum calcium levels in the infants were similar in both groups. Maternal 6000 IU/day vitamin D3 supplementation alone safely optimizes maternal vitamin D status, improves milk vitamin D to maintain adequate infant serum 25(OH)D. It thus provides an alternative option to prevent the burden of vitamin D deficiency in exclusively breastfeeding infants in high-risk populations and warrants further study of the effective dose.

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Low serum sclerostin levels in newborns with vitamin D deficiency

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0222 ◽

2016 ◽

Vol 29 (4) ◽

Cited By ~ 1

Author(s):

Ozgur Pirgon ◽

Gonca Sandal ◽

Hasan Cetin ◽

Bumin Dundar

Keyword(s):

Vitamin D ◽

Alkaline Phosphatase ◽

Calcium Phosphate ◽

Bone Turnover ◽

Vitamin D Deficiency ◽

Vitamin D Status ◽

Lower Serum ◽

Clinical Marker ◽

Sclerostin Level ◽

Low Serum

AbstractSclerostin is a glycoprotein produced by osteocytes that is being evaluated as a potential clinical marker of bone turnover. The aim of this study was to investigate the association between neonatal vitamin D status and levels of circulating sclerostin.Forty newborns were recruited for the study. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D3 [25(OH)D] concentration <20 ng/mL and the newborns were divided into two groups as vitamin D deficient and vitamin D sufficient groups. Calcium, phosphate, alkaline phosphatase and sclerostin were measured at birth.Newborns with vitamin D deficiency had markedly lower 25(OH)D levels than vitamin D sufficient newborns (8.5±4.4 ng/mL vs. 35.3±10.6 ng/mL, p<0.001). Vitamin D deficient infants also had significantly lower serum sclerostin levels (188.4±21.9 vs. 282.3±30.4 pg/mL; p: 0.026) than vitamin D sufficient newborns at birth. However, we did not detect a significant linear association between neonatal sclerostin and maternal/neonatal 25(OH)D levels.Our data also demonstrated that vitamin D deficient newborns exhibited lower sclerostin levels than vitamin D sufficient newborns. The low sclerostin level might serve as a marker of decreased osteocyte activity in newborns with vitamin D deficiency.

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Vitamin D Metabolism Is Significantly Impaired in COVID-19 Inpatients

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.572 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A281-A282

Author(s):

Alexandra Povaliaeva ◽

Liudmila Ya Rozhinskaya ◽

Ekaterina A Pigarova ◽

Larisa K Dzeranova ◽

Nino N Katamadze ◽

...

Keyword(s):

Vitamin D ◽

Secondary Hyperparathyroidism ◽

Vitamin D Deficiency ◽

Serum Calcium ◽

Vitamin D Supplementation ◽

Vitamin D Metabolites ◽

Lung Involvement ◽

Hydroxylase Activity ◽

Vitamin D Metabolism ◽

Vitamin D Levels

Abstract Objective: to assess the state of vitamin D metabolism in patients hospitalized with COVID-19 infection. Materials and methods: We examined 49 patients, which were hospitalized for inpatient treatment of COVID-19 infection from May to June 2020. Study group included 24 men (49%) and 25 women (51%), median age 58 years [48; 70], BMI 26.4 kg/m2 [24.3; 30.5]. All patients were diagnosed with pneumonia due to SARS-CoV-2 with median percent of lung involvement equal to 29% [14; 37], 22 patients (45%) required oxygen support upon admission. Median SpO2 was equal to 95% (92; 97), median NEWS score was equal to 3 [2; 6]. Participants were tested for vitamin D metabolites (25(OH)D3, 1,25(OH)2D3, 3-epi-25(OH)D3, 24,25(OH)2D3 and D3) by UPLC-MS/MS, free 25(OH)D and vitamin D-binding protein by ELISA, as well as PTH by electrochemiluminescence immunoassay and routine biochemical parameters of blood serum (calcium, phosphorus, albumin) at the time of admission. Results: patients had in general very low 25()D3 levels - median 10.9 ng/mL [6.9; 15.6], corresponding to a pronounced vitamin D deficiency in half of the patients. Levels of 24,25(OH)2D3 were also low – 0.5 ng/mL [0.2; 0.9], and resulting vitamin D metabolite ratios (25(OH)D3/24,25(OH)2D3) were high-normal or elevated in most patients – 24.1 [19.0; 39.2], indicating decreased activity of 24-hydroxylase. Levels of 1,25(OH)2D3, on the contrary, were high-normal or elevated - 57 pg/mL [46; 79], which, in accordance with 25(OH)D3/1,25(OH)2D3 ratio (219 [134; 266]) suggests an increase in 1α-hydroxylase activity. Median level of 3-epi-25(OH)D3 was 0.7 ng/mL [0.4; 1.0] and D3 metabolite was detectable only in 6 patients. Median DBP level was 432 mg/L [382; 498], median free 25(OH)D was 5.6 pg/mL [3.3; 6.7], median calculated free 25(OH)D was 2.0 pg/mL [1.4; 3.3]. Most patients had albumin-adjusted serum calcium level in the lower half of reference range (median 2.24 mmol/L [2.14; 2.34]). Seven patients had secondary hyperparathyroidism and one patient had primary hyperparathyroidism, the rest of the patients had PTH levels within the normal range.25(OH)D3 levels showed significant negative correlation with percent of lung involvement (r = -0.36, p<0.05) and positive correlation with SpO2 (r = 0.4, p<0.05). 1,25(OH)2D3 levels correlated positively with 25(OH)D3 levels (r = 0.38, p<0.05) and did not correlate significantly with PTH levels (p>0.05). Conclusion: Our data suggests that hospitalized patients with COVID-19 infection have significant impairment of vitamin D metabolism, in particular, an increase in 1α-hydroxylase activity, which cannot be fully explained by pre-existing conditions such as vitamin D deficiency and secondary hyperparathyroidism. The observed profound vitamin D deficiency and association of vitamin D levels with markers of disease severity indicate the importance of vitamin D supplementation in these patients.

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Vitamin D Deficiency is Associated with Increased COVID-19 Severity: Prospective Screening of At-Risk Groups is Medically Indicated

10.21203/rs.3.rs-83262/v1 ◽

2020 ◽

Author(s):

Samuel H Pepkowitz ◽

Calvin J Hobel ◽

James M Mirocha MS ◽

Kimia.Sobhani ◽

Carissa A Huynh BS ◽

...

Keyword(s):

At Risk ◽

Vitamin D ◽

Immune System ◽

Vitamin D Deficiency ◽

Hospital Admissions ◽

Serum Vitamin ◽

Risk Groups ◽

Population Groups ◽

Serum Vitamin D ◽

Low Serum

Abstract Non-classical actions of Vitamin D are involved in regulation of the immune system including a role in mitigation of excessive inflammation. We hypothesized that vitamin D deficiency existing prior to SARS-CoV-2 infection could contribute to patients developing severe pulmonary compromise as a result of dysfunctional hyperinflammation. Serum vitamin D concentrations of patients experiencing such severe COVID-19 manifestations that they required ICU care at any point of their hospitalization were compared to serum vitamin D concentrations of patients achieving discharge without the need for any ICU care. Having serum vitamin D < 20 ng/mL was significantly associated with increased COVID-19 severity, p=0.001. It is conjectured that population groups know to have low serum vitamin D should be prospectively screened for deficiency and if found emergently treated. Such action could both decrease the maximum severity suffered by infected individuals and lessen the strain on medical resources by decreasing the percentage of COVID-19 hospital admissions requiring ICU care.

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Association of maternal serum vitamin D level with preeclampsia or eclampsia and its relationship with neonatal outcome and neonatal serum calcium level

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175285 ◽

2017 ◽

Vol 6 (12) ◽

pp. 5580 ◽

Cited By ~ 1

Author(s):

Mahija Sahu ◽

Sonali Tripathy ◽

Pallavi Bhuyan

Keyword(s):

Vitamin D ◽

Vitamin D Deficiency ◽

Serum Calcium ◽

Calcium Level ◽

Neonatal Outcome ◽

Serum Vitamin ◽

Maternal Serum ◽

Third Trimester ◽

Serum Vitamin D ◽

Pregnant Females

Background: Vitamin D deficiency has been associated with various poor maternal and fetal outcome and is proposed to be important in the pathogenesis of preeclampsia. The aim of the study was to evaluate the serum vitamin-D levels in normal pregnant females and pre-eclampsia or eclampsia individuals in the third trimester admitted for termination or in labour and to assess the neonatal outcome and neonatal serum calcium levels of babies born to mother in both the groups.Methods: This study was a prospective comparative study carried out on the pregnant women in the third trimester admitted for termination or in labour. 100 pregnant females with either pre-eclampsia or eclampsia were compared with equal number of normotensive pregnant females for serum vitamin D. They were followed up until delivery and subsequently neonatal serum calcium level was estimated.Results: Most pregnant females had vitamin D deficiency pointing towards universal prevalence. Only 10% had suboptimal to optimal vitamin D level while 90% had vitamin deficiency. The hypertensive group had lower mean serum vitamin D level (9.06±5.20 ng/ml) as compared to normotensive group (13.67±7.24 ng/ml). Neonatal outcome was poorer in the hypertensive group. Neonates born to hypertensive mothers had lower mean calcium level (8.30±1.46mg/dl) when compared to those born to normotensive mothers (8.82±0.918mg/dl).Conclusion: The study findings revealed that there lies a consistent association of maternal serum vitamin D deficiency with the hypertensive disorders of pregnancy and neonatal morbidity.

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