Serum Levels of Vitamin C and Vitamin D in a Cohort of Critically Ill COVID-19 Patients of a North American Community Hospital Intensive Care Unit in May 2020: A Pilot Study.

Cristian Arvinte, Maharaj Singh, Paul E Marik

Journal: Medicine in drug discovery 2020;8():100064

PMID: 32964205

Free Full Text on Elsevier Science View on PubMed

Plain Language Summary

The emergence of the Covid-19 pandemic has necessitated the research of novel ways to decrease infection risk and severity of the disease. Recent research has implicated vitamin C and vitamin D levels as possible indicators for susceptibility to Covid-19 and as nutrient therapies in those who have already contracted the disease. This pilot observational cohort study aimed to measure serum vitamin C and vitamin D levels in patients with Covid-19. 21 critically ill Covid-19 patients were enrolled into the study, of which 11 survived. Serum vitamin C and vitamin D levels were collected as part of routine testing. The results showed that the Covid-19 patients in this study had low vitamin C, D2 and D3 levels but it is unclear whether these were significant, due to the small number of people in the study. Age was a significant predictor for death from Covid-19 and for every increase of 10 years, risk of death increased by nearly 3-fold, which was partly attributed to low vitamin C levels. However low vitamin C levels or age alone were not predictors for mortality. It was concluded that low vitamin C and D levels were detected in this cohort of Covid-19 patients and that age and vitamin C levels combined contributed to mortality risk, however many more hypotheses were generated. Clinicians could use this study to help further understand the importance of monitoring vitamin C and D levels in someone with Covid-19.

Abstract

BACKGROUND

The COVID-19 pandemic has placed an enormous and growing burden on the population and health infrastructure, warranting innovative ways to mitigate risk of contracting and developing severe forms of this disease. A growing body of literature raises the issue of vitamin C and vitamin D as a risk-assessment tool, and therapeutic option, in COVID-19.

OBJECTIVE

The objective of this pilot study was to measure serum vitamin C and vitamin D levels in a cohort of patients with critical COVID-19 illness in our community hospital ICU, correlate with other illness risk factors (age, BMI, HgbA1c, smoking status), generate hypotheses, and suggest further therapeutic intervention studies.

METHOD

This pilot study included all 21 critically ill COVID-19 patients hospitalized in May 2020 in the ICU of North Suburban Medical Center, Thornton, Colorado, in whose care the principal investigator (C.A.) was involved. We measured patients' serum vitamin C and vitamin D levels, and standard risk factors like age, BMI, HbA1c, and smoking status. Variables in this study were gauged using descriptive statistics.

RESULTS

Of 21 critically ill COVID-19 patients (15 males and 6 females, 17 Hispanic and 4 Caucasian, of median age 61 years, range 20-94), there were 11 survivors.Serum levels of vitamin C and vitamin D were low in most of our critically ill COVID-19 ICU patients.Older age and low vitamin C level appeared co-dependent risk factors for mortality from COVID-19 in our sample.Insulin resistance and obesity were prevalent in our small cohort, but smoking was not.

CONCLUSION

Our pilot study found low serum levels of vitamin C and vitamin D in most of our critically ill COVID-19 ICU patients. Older age and low vitamin C level appeared co-dependent risk factors for mortality. Many were also insulin-resistant or diabetic, overweight or obese, known as independent risk factors for low vitamin C and vitamin D levels, and for COVID-19.These findings suggest the need to further explore whether caring for COVID-19 patients ought to routinely include measuring and correcting serum vitamin C and vitamin D levels, and whether treating critically ill COVID-19 warrants acute parenteral vitamin C and vitamin D replacement.

Address: Intensivist & Pulmonologist, North Suburban Medical Center, Thornton, Colorado 80229, USA.; Research Assistant Professor, Biostatistics, Research and Graduate Studies, Marquette University, School of Dentistry, Milwaukee, Wisconsin 53201, USA.; Biostatistician Senior, Advocate Aurora Research Institute, Advocate Aurora Health Care, Milwaukee, Wisconsin, 53233, USA.; Chief, Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.

DOI: 10.1016/j.medidd.2020.100064