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Sanecka M, Youssef M, Abdulsalam M, Raza SF, Qadeer A, Ioana J, Aldoresi A, Shah SI, Al Lawati A, Feely J, Tormey WP, O'Neill E, Cormican LJ, Judge EP, McCartney DMA, Faul JL. Hospital Outcomes in Patients Hospitalized for COVID-19 Pneumonia: The Effect of SARS-CoV-2 Vaccination and Vitamin D Status. Nutrients 2023; 15:2976. [PMID: 37447302 DOI: 10.3390/nu15132976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
SARS-CoV-2 vaccination promises to improve outcomes for patients with COVID-19 pneumonia (most notably those with advanced age and at high risk for severe disease). Here, we examine serum 25-Hydroxyvitamin D (25(OH)D) status and outcomes in both old (>70 years) and young vaccinated (n = 80) and unvaccinated (n = 91) subjects, who were hospitalized due to COVID-19 pneumonia in a single center (Connolly Hospital Dublin). Outcomes included ICU admission and mortality. Serum 25(OH)D levels were categorized as D30 (<30 nmol/L), D40 (30-49.99 nmol/L) and D50 (≥50 nmol/L). In multivariate analyses, D30 was independently associated with ICU admission (OR: 6.87 (95% CI: 1.13-41.85) (p = 0.036)) and mortality (OR: 24.81 (95% CI: 1.57-392.1) (p = 0.023)) in unvaccinated patients, even after adjustment for major confounders including age, sex, obesity and pre-existing diabetes mellitus. While mortality was consistently higher in all categories of patients over 70 years of age, the highest observed mortality rate of 50%, seen in patients over 70 years with a low vitamin D state (D30), appeared to be almost completely corrected by either vaccination, or having a higher vitamin D state, i.e., mortality was 14% for vaccinated patients over 70 years with D30 and 16% for unvaccinated patients over 70 years with a 25(OH)D level greater than 30 nmol/L. We observe that high mortality from COVID-19 pneumonia occurs in older patients, especially those who are unvaccinated or have a low vitamin D state. Recent vaccination or having a high vitamin D status are both associated with reduced mortality, although these effects do not fully mitigate the mortality risk associated with advanced age.
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Affiliation(s)
- Martyna Sanecka
- School of Biological, Health & Sports Sciences, Technological University Dublin, D07 XT95 Dublin, Ireland
| | - Modar Youssef
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Mohammad Abdulsalam
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Syed F Raza
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Abdul Qadeer
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Julia Ioana
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Alya Aldoresi
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Syed I Shah
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Abdul Al Lawati
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Joseph Feely
- Department of Biochemistry, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - William P Tormey
- Department of Biochemistry, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Eoghan O'Neill
- Department of Microbiology, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Liam J Cormican
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Eoin P Judge
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
| | - Daniel M A McCartney
- School of Biological, Health & Sports Sciences, Technological University Dublin, D07 XT95 Dublin, Ireland
| | - John L Faul
- Department of Respiratory and Sleep Medicine, Connolly Hospital Dublin, D15 X40D Dublin, Ireland
- Department of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
- Department of Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
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Mayoral EPC, Hernández-Huerta MT, Pérez-Campos Mayoral L, Matias-Cervantes CA, Mayoral-Andrade G, Barrios LÁL, Pérez-Campos E. Factors related to asymptomatic or severe COVID-19 infection. Med Hypotheses 2020; 144:110296. [PMID: 33254487 PMCID: PMC7513914 DOI: 10.1016/j.mehy.2020.110296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 01/22/2023]
Abstract
The factors that may contribute to a COVID-19 patient remaining in the asymptomatic stage, or to the infection evolving into the more serious stages are examined. In particular, we refer to the TMPRSS2 expression profile, balance of androgen and estrogen, blood group-A and/or B, nonsynonymous mutations in ORF3, and proteins NS7b and NS8 in SARS-CoV-2. Also, we review other factors related to the susceptibility and pathogenicity of SARS-CoV-2.
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Affiliation(s)
- Eduardo Pérez-Campos Mayoral
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca 68020, Mexico; Laboratorio de Patología Clinica "Eduardo Pérez Ortega", Oaxaca 68000, Mexico
| | - María Teresa Hernández-Huerta
- CONACyT, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca 68020, Mexico; Laboratorio de Patología Clinica "Eduardo Pérez Ortega", Oaxaca 68000, Mexico
| | - Laura Pérez-Campos Mayoral
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca 68020, Mexico; Laboratorio de Patología Clinica "Eduardo Pérez Ortega", Oaxaca 68000, Mexico.
| | - Carlos Alberto Matias-Cervantes
- CONACyT, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca 68020, Mexico; Laboratorio de Patología Clinica "Eduardo Pérez Ortega", Oaxaca 68000, Mexico
| | - Gabriel Mayoral-Andrade
- Centro de Investigación Facultad de Medicina UNAM-UABJO, Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca 68020, Mexico; Laboratorio de Patología Clinica "Eduardo Pérez Ortega", Oaxaca 68000, Mexico
| | - Luis Ángel Laguna Barrios
- Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca 68020, Mexico; Laboratorio de Patología Clinica "Eduardo Pérez Ortega", Oaxaca 68000, Mexico
| | - Eduardo Pérez-Campos
- Facultad de Medicina y Cirugía, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca 68020, Mexico; Tecnológico Nacional de México/IT Oaxaca, Oaxaca 68020, Mexico; Laboratorio de Patología Clinica "Eduardo Pérez Ortega", Oaxaca 68000, Mexico.
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Yalla N, Bobba G, Guo G, Stankiewicz A, Ostlund R. Parathyroid hormone reference ranges in healthy individuals classified by vitamin D status. J Endocrinol Invest 2019; 42:1353-1360. [PMID: 31273631 PMCID: PMC6790182 DOI: 10.1007/s40618-019-01075-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/11/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Parathyroid hormone (PTH) concentrations are routinely measured in the diagnosis and management of bone and kidney diseases, but reference ranges can be overestimated if determined in otherwise healthy individuals for whom vitamin D deficiency was not evaluated. We establish PTH reference ranges in apparently healthy, normocalcemic, normophosphatemic individuals categorized by 25-hydroxyvitamin D (25(OH)D) status using the Elecsys® PTH (cobas e 601) and Elecsys® Vitamin D total II electrochemiluminescence immunoassays (cobas e 411). METHODS This prospective, non-interventional study measured PTH in serum from 653 apparently healthy adults [56.7% female; 68.2% white/Caucasian; 28.6% African American; median age 44 years (range 21-83)] from three diverse geographic sites across the USA during summer and winter months. Subjects were classified by concomitant vitamin D sufficiency (≥ 30 ng/mL), insufficiency (> 20 to < 30 ng/mL) or deficiency (≤ 20 ng/mL). RESULTS In vitamin D sufficiency, median PTH was 31.9 pg/mL [range (2.5th-97.5th percentile) 17.9-58.6] compared with 35.5 pg/mL (17.0-60.4) for insufficiency, and 39.8 pg/mL (19.5-86.4) for deficiency. A significant inverse relationship was found between PTH and 25(OH)D (P < 0.001). After accounting for vitamin D, potential effects of race or season as covariates were relatively small or absent. CONCLUSIONS Upper reference limits (URL) for PTH in vitamin D sufficiency/insufficiency were similar and lower than current values. Clinically important PTH elevations were observed in vitamin D deficiency, where revised reference ranges with a higher URL may be appropriate. These data may help to distinguish vitamin D-related PTH elevations from other causes [e.g., primary (normocalcemic) or secondary hyperparathyroidism].
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Affiliation(s)
- N Yalla
- Washington University, St. Louis, MO, USA
| | - G Bobba
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | - G Guo
- Roche Diagnostics Inc., Indianapolis, IN, USA
| | | | - R Ostlund
- Washington University, St. Louis, MO, USA.
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Naderpoor N, Mousa A, de Courten M, Scragg R, de Courten B. The relationship between 25-hydroxyvitamin D concentration and liver enzymes in overweight or obese adults: Cross-sectional and interventional outcomes. J Steroid Biochem Mol Biol 2018; 177:193-199. [PMID: 28899715 DOI: 10.1016/j.jsbmb.2017.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/07/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Abstract
Vitamin D deficiency is prevalent in individuals with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis. However, there is limited and inconsistent data on the effect of vitamin D supplementation on liver function. Hepatic enzymes have been used as surrogate markers for NAFLD and have been associated with metabolic syndrome. We examined the relationships between 25-hydroxyvitamin D (25(OH)D) and γ-glutamyl transferase (GGT), alanine aminotransferase (ALT), alkaline phosphatase (ALP) in 120 drug-naïve individuals with no history of liver disease. In addition, the effect of vitamin D supplementation (100,000 loading dose of cholecalciferol followed by 4000IU daily for 16 weeks) on hepatic enzymes was investigated in a subgroup of 54 vitamin D-deficient overweight or obese individuals (28 randomised to cholecalciferol and 26 to placebo). Hepatic enzymes, anthropometric parameters, lipid profile, insulin sensitivity (hyperinsulinaemic-euglycaemic clamp, M value) and high sensitivity C-reactive protein (hs-CRP) were measured before and after the intervention. In the cross-sectional study, levels of GGT and ALT were higher in men compared to women (both p=0.001). There were no significant differences in GGT, ALT and ALP between vitamin D categories (25(OH)D<25nmol/L, 25-50nmol/L, and >50nmol/L) and no relationships were found between the three enzymes and 25(OH)D before and after adjustment for age, sex, BMI, WHR, and insulin sensitivity (all p>0.5). In the randomised trial, 25(OH)D concentrations increased in the vitamin D group (mean change 57.0±21.3nmol/L) compared to the placebo group (mean change 1.9±15.1nmol/L). Mean changes in GGT, ALT and ALP were not significantly different between vitamin D and placebo groups (all p>0.2). Change in 25(OH)D concentration was not correlated with changes in GGT, ALT and ALP before and after adjustments for age and sex (all p>0.1). In summary, 25(OH)D concentrations were not related to hepatic enzymes in drug-naive adults with no history of liver disease, and vitamin D supplementation had no effect on the serum levels of hepatic enzymes in vitamin D-deficient and overweight or obese, otherwise healthy individuals. Hence, vitamin D supplementation is unlikely to prevent incident NAFLD.
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Affiliation(s)
- Negar Naderpoor
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC 3168, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia
| | | | - Robert Scragg
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Barbora de Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia; Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, VIC 3168, Australia.
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