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Vitamin D Deficiency In COVID-19: Is It Associated With Increased Severity Of Disease?

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WhiteBoard style discussion on a study published in Clinical Endocrinology looking at the severity of COVID-19 disease and Vitamin D levels. They tested Vitamin D levels in patients admitted to the hospital with COVID-19. They found an association between severity of disease and Vitamin D deficiency. We will discuss the metabolic pathway that leads to the active form of Vitamin D called calcitriol, the organs involved in Vitamin D synthesis, and the physiology associated with Vitamin D.

Hey everybody welcome back to another video quick plug for the channel this is a medical education channel meant to provide free open access medical education uh we’ve been doing a lot of covet 19 content and please feel free to check it out after that though we hope to get back into kind of general great medical education for you also feel free to subscribe

And follow along today we’re going to be talking about a small um study actually in the form of a letter to the editor in the journal of clinical endocrinology and it’s a play-off of endocrinology that looks better it’s a play-off of um the video we did the other day that actually included this study as part of kind of the background for why they did the study

They did and i want to just do kind of a brief um pathophysiology of vitamin d because i think it’s helpful and then we’ll dive into the study so they used low serum 25 hydroxy vitamin d they tested for it and looked at low levels and whether that was associated with greater disease severity of covid19 so vitamin d is a very important signaling molecule in the

Body and it takes on a few different forms and they specifically looked at 25 hydroxy vitamin d so what we have here is the skin and for some reason i decided to draw the skin with you know hair follicles inhalers and exocrine glands and different layers i don’t know why um seems unnecessary now that i’m reflecting on it but in the skin we have seven d high um

Let’s see if i can pronounce this d hydrocholesterol and the sunshine uv rays come down and hit the skin and convert this dehydrocholesterol to cole calciferol cipheral and this goes to the liver and there it gets converted into 25 hydroxy vitamin d also known as the abbreviation that we’ve used before which is 25 oh d3 and this is an active precursor that

Then goes to the kidney so this is the liver here yay liver and this is a kidney here so it goes to then the kidney and in the kidney it gets converted into its active form 1 25 hydroxy vitamin d3 which is the active metabolite this is also called calcitriol all right and this one is actually also called calcifidiol so when you’re looking at studies or reading

About vitamin d you’ll see a few different kind of versions and forms used and that’s why so the kidney secretes then the active form and this active form of vitamin d circulates in the blood and it’s lipophilic so it can go through fat so it diffuses into the human cell this here is a human cell this is the nucleus of the human cell and it goes into the nucleus

And it actually affects dna you know transcription translation to proteins so it kind of causes a shift in what the dna is transcribed and translated into to then affect what proteins are created and then change the functionality of the cell so it works on gene transcription okay so these authors went ahead and said look we look at sars cov2 and covid19 and we

See that there’s a higher mortality in certain patients and these are patients that are male right elderly obese have hypertension diabetes live at higher altitudes actually or colder climates so low temperatures or have darker skin and these authors say well all these things are also associated with higher rates of vitamin d deficiency vitamin d deficiency

Breathing would be being abbreviated vdd vitamin d deficiency so they said maybe the thing that actually ties all these things together is vitamin d deficiency and that that deficiency is actually what increases our risk for higher mortality so the study looked at 134 individuals primarily caucasian who lived in north england all right and there were patients

That were inpatient so admitted into the hospital that were either pcr positive or suspicious four stars cov2 right the virus causing covid19 so they didn’t have to be pcr positive they also could just be radiograph suspicious and they then tested their vitamin d levels and they said if the vitamin d level is greater than 50 nanomoles per liter we’ll call that

Normal and less than that will be deficient and they went back and looked at 134 of these patients and found certain things the suspense so this here is a table looking at the two groups right so their outcomes was that they were looking at intensive care unit is what we call it i guess in england they call it intensive therapy unit the itu and they tested

Whether patients in the itu were more likely to have vitamin d deficiency in addition to that though they kind of teased out how old they were comorbidities and such to see if something else could be contributing to any possible results so here we have p values right and here we have non-intensive therapy unit and more intensive therapy unit and parenthesis i’m

Going to put intensive care unit because that’s what we call it in the states so we can see here right p values of less than .05 are statistically significant right equal statistic significance that looks like an i but it’s an equal so we can see here that less than .05 is here so the actually non-intensive therapy unit wears older believe it or not so there’s

A younger patient population in the intensive therapy unit otherwise there is no statistically significant difference in ethnicities between the intensive therapy unit the non-intensity therapy unit there was a difference in those who had high blood pressure and those that had obesity and you can actually see here that the intensity intensive therapy unit had a

Higher percentage of patients with hypertension and with obesity than the non-intensity therapy unit but if you look at all comorbidities together you actually see that there was 85 of patients were comorbid in the non-intensity of therapy unit compared to 83 in the intensive therapy unit so even though there’s more patients with high blood pressure and with obesity

Overall there is more patience with comorbidities in the non-intensive therapy unit all right then we look at kind of blood pressures no significance heart rate no significance there was a higher respiratory rate in the intensive therapy unit patients right these are critically ill patients so that’s not a surprise and there was a higher body temperature as well

And again they’re in the intensive care unit or the intensive therapy unit for a reason there’s no difference in oxygen saturation lymphocyte count eosinophil count there was a just barely significant difference in crpc reactive protein that’s inflammatory markers so it was higher in those in the intensive therapy unit no difference of procalcitonin no difference

In general nanimals of 25 hydroxy vitamin d but there was a statistically significant difference in those that were vitamin d deficient so there is a higher percentage of patients in the intensive therapy unit right who were vitamin d deficient as compared to those in the non-intensive therapy unit so this is a letter to the editor meaning it’s kind of a short

Small study and this is the main result of the study is this table here and these authors propose that although no conclusion can be drawn it is interesting that those in the intensive therapy unit meaning the more critically ill patients with covid19 by either pcr or radiograph were younger yet sicker because they’re in the intensive therapy unit and even

Though they were younger they were more likely to have vitamin d deficiency so they said this is you know we’re just simply pointing out that it’s interesting that this younger population was sicker and then they also happen to have more vitamin d deficiency so could that vitamin d deficiency have been contributing to their severity of illness all right now

Distractors right i shouldn’t say distractors possible confounders they also had more hypertension and more diabetes which we know are associated with severity of disease but with that being said right there was actually more comorbidity in general although not statistically significant in the non-intensive therapy unit patients than in the intensive therapy

Unit patients right remember it was the 85 percent compared to 83 percent so could it be the hypertension could be the diabetes that made them sicker rather than vitamin d deficiency it definitely could but still kind of just an interesting thing to ponder um and that’s why it’s a letter to the editor and it’s something that’s just kind of pointing out that we

Found this association we can’t quite say for sure what it means but there’s an association there to further tease out so the general results the conclusions are that 19 of the intensive therapy unit patients were vitamin d replete right replete meaning that they were not deficient so 19 were not deficient in vitamin d despite them being younger despite them

Being younger and that they being in the intensive therapy unit were sicker than those in the non-intensive therapy unit with the question being could it be related to the fact could the fact that they were sick or be related to the fact that they were more vitamin d deficient now a huge number of limitations right this is a letter to the editor it cannot be

Used to kind of support anything in particular um right it’s a very small study it’s not an ethically diverse study can’t really make any conclusions but still an interesting study kind of nonetheless given the the evidence out there building and the current trial is underway i’m looking at vitamin d and cove at 19. so thanks for checking out the video let us

Know questions comments concerns you have down below feel free to hit subscribe and follow along we’d love to have you in the whiteboard doctor community and we will see you all next time thanks for watching stay healthy

Transcribed from video
Vitamin D Deficiency In COVID-19: Is It Associated With Increased Severity Of Disease? By Whiteboard DoctorliveBroadcastDetails{isLiveNowfalsestartTimestamp2020-09-24T220052+0000endTimestamp2020-09-24T221452+0000}