Abstract
The coronavirus disease 2019 (COVID-19) pandemic has generated high interest in factors modulating risk of infection, disease severity and recovery. Vitamin D has garnered interest since it is known to modulate immune function and vitamin D deficiency is associated with increased risk of respiratory infections and adverse health outcomes in severely ill patients. There are no population representative data on the direct relationship between vitamin D status and severe acute respiratory syndrome coronavirus 2 infection risk and severity of COVID-19. Data from intervention studies are limited to four studies. Here we summarise findings regarding vitamin D status and metabolism and their alterations during severe illness, relevant to COVID-19 patients. Further, we summarise vitamin D intervention studies with respiratory disease outcomes and in critically ill patients and provide an overview of relevant patient and population guidelines. Vitamin D deficiency is highly prevalent in hospitalised patients, particularly when critically ill, including those with COVID-19. Acute and critical illness leads to pronounced changes in vitamin D metabolism and status, suggestive of increased requirements. This needs to be considered in the interpretation of potential links between vitamin D status and disease risk and severity and for patient management. There is some evidence that vitamin D supplementation decreases the risk of respiratory tract infections, while supplementation of intensive care unit patients has shown little effect on disease severity or length of treatment. Considering the high prevalence of deficiency and low risks associated with supplementation, pro-actively applying current population and patient management guidelines to prevent, monitor and correct vitamin D deficiency is appropriate.
Highlights
Coronavirus disease 2019 (COVID-19) is causing worldwide morbidity and mortality
The contrasting findings between observational, mechanistic and intervention studies suggest that many other factors play a role; the beneficial effects of vitamin D may be limited to specific subgroups, the alterations in vitamin D metabolism with disease processes may influence its function and/or other drivers of the immune and inflammatory response may be predominant, in severe illness
No data are yet available demonstrating a causative link between low vitamin D status and susceptibility for COVID-19 or its disease course
Summary
Coronavirus disease 2019 (COVID-19) is causing worldwide morbidity and mortality. The aetiology and progression of the – initially – respiratory disease in those severely affected is complex and affects many organ systems. Considering the potential multifactorial role of vitamin D (and status and supplementation) in different stages and aspects of the response to viral infection and subsequent development of symptoms, time since infection and development of (severe) symptoms relative to the start of supplementation as well as baseline 25(OH)D concentrations may be important factors to consider in the evaluation of the effect of interventions This is supported by secondary outcomes reported by Nogues[20]. The contrasting findings between observational, mechanistic and intervention studies suggest that many other factors play a role; the beneficial effects of vitamin D may be limited to specific subgroups, the alterations in vitamin D metabolism with disease processes may influence its function and/or other drivers of the immune and inflammatory response may be predominant, in severe illness. According to the free hormone theory, cellular uptake in these extra-renal tissues is thought to be concentration dependent and is reduced when 25(OH)D is low (see further below)
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