Relationship Between Vitamin D Levels and Covid-19 Severity Due to Circulating SARS-COV-2 Variants in Argentina: A Presentation of Clinical Cases
Introduction
During the current pandemic of atypical pneumonia caused by the SARS-CoV-2 coronavirus, it has been observed that vitamin D (VD) deficiency would represent a significant risk factor in the severity and prognosis of COVID-19 with a higher prevalence of hypertension and cardiovascular diseases. As of August 2021, Argentina was the second Latin American country with the highest number of confirmed cases and the fifth with the highest number of deaths from COVID-19, according to official statistics [1], despite having been subjected to one of the longest quarantines of the world, which justifies and strengthens the selection of this country to carry out research works such as the one presented here. Previous studies consider that the weighted average prevalence of VD deficiency in the Argentine adult population is around 43.3% [2]. In this context, the present study aimed to investigate the possible relationship between the evolution of the disease concerning serum VD levels in a series of clinical cases of patients with COVID-19. They were admitted to the critical care area of Hospital Luis Carlos Lagomaggiore, Mendoza, Argentina.
Presentation of the Series of Clinical Cases
We present a series of 5 patients, 2 men and 3 women in an age range of 25 to 86 years, with a positive diagnosis by polymerase chain reaction (PCR) to detect SARS-CoV-2. They all required admission to the critical care unit due to acute respiratory failure and received the standard care recommended to manage this pathology (invasive hemodynamic monitoring, mechanical ventilation, and other procedures). Table 1 shows the clinical cases and the most outstanding variables analyzed. Biochemical/ inflammatory parameters were requested (vitamin D, D-Dimer, ferritin, ultrasensitive C-reactive protein, blood count, among others). Likewise, ventilatory mechanics measurements were performed at the time of linkage to mechanical ventilation (MRA). As observed in the series of cases presented, the serum VD levels in all the patients analyzed are below what is established as normal or sufficient levels of VD (> 30 ng/mL), reaching not only levels of insufficiency (<30 ng/mL),but even VD deficiency (<20ng/mL). Regarding mortality, of the total sample (100%), 2 (40%) patients died. The deceased patients were identified as 3 and 4, and they also had the lowest values in the VD dosage (7.98 ng/mL and 17.3 ng/mL, respectively).
Discussion
The 5 patients studied showed a significant increase in inflammatory parameters, accounting for the severity of the COVID-19 developed, starring the characteristic cytokine storm. Consistent with our results, some previous studies have suggested the existence of an inverse relationship between serum VD levels and the degree of severity due to COVID-19 [3–8]. However, none of them has specifically evaluated this relationship in patientsaffected by the variants of SARS-CoV-2 Gamma (Manaus) and Lambda (Andina), with a majority presence in Argentina at the date of this study [9].Therefore, the importance of this research is fundamentally in that its results would contribute significantly to establish an inverse relationship between serum levels of VD and severity of COVID-19 in patients infected by the variants mentioned above, representing an essential contribution to the genomic surveillance process [10], not only in Argentina, if not in all those countries in the world that are mainly affected by the presence of the Lambda and Gamma variants. This contribution would significantly improve the prevention and treatment of COVID-19, mainly when any of these variants develops the infection. Likewise, additional studies should be performed in populations with another viral circulation profile to evaluate this relationship (VD levels vs COVID-19 severity) versus other SARS-CoV-2 variants.
Authors’ Contribution
All authors contributed in the same way in the conception and design of the review, with a substantial contribution on the data, analysis and interpretation of the contents, writing and critical review of the article for its intellectual content.
Declaration of Conflict of Interest
The authors declare no potential conflicts of interest concerning the research, authorship and/or publication of this article.
Financial Support
The authors declare that they have not received financial support for the research, authorship and/or publication of this article.