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.
Keywords: Age; Body mass index (BMI); COVID-19; Critical illness; HbA1c (glycated hemoglobin); Intensive care unit (ICU); SARS-CoV-2; Serum vitamin C; Serum vitamin D.
© 2020 The Authors.
Conflict of interest statement
The authors of this paper have had no conflicts of interest in conducting and publishing this research.
Feeding the critically ill obese patient: a systematic review protocol.JBI Database System Rev Implement Rep. 2015 Oct;13(10):95-109. doi: 10.11124/jbisrir-2015-2458.PMID: 26571286
Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort.EClinicalMedicine. 2020 Aug;25:100449. doi: 10.1016/j.eclinm.2020.100449. Epub 2020 Jul 6.PMID: 32838231 Free PMC article.
Significance of low serum vitamin D for infection risk, disease severity and mortality in critically ill patients.Chin Med J (Engl). 2013 Jul;126(14):2725-30.PMID: 23876904
Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit.Cochrane Database Syst Rev. 2018 Mar 27;3(3):CD010754. doi: 10.1002/14651858.CD010754.pub2.PMID: 29582429 Free PMC article. Review.
Vitamin D in the ICU: More sun for critically ill adult patients?Nutrition. 2019 May;61:173-178. doi: 10.1016/j.nut.2018.11.001. Epub 2018 Nov 16.PMID: 30731421 Review.
Cited by 1 article
The Emerging Role of Vitamin C in the Prevention and Treatment of COVID-19.Nutrients. 2020 Oct 27;12(11):3286. doi: 10.3390/nu12113286.PMID: 33121019 Free PMC article.
- Incipient Scurvy Lancet. 22 September 1917;190(Issue 4908):465–466. doi: 10.1016/S0140-6736(01)52008-5. – DOI
- McCartney D.M., Byrne D.G. Optimization of Vitamin D Status for Enhanced Immuno-protection Against Covid-19. Ir Med J. 2020;113(4):58. http://www.indymedia.ie/attachments/may2020/covid-19_vit_d_irish_med_j_mcc…” rel=”noopener nofollow noopener” title=”External link: http://www.indymedia.ie/attachments/may2020/covid-19_vit_d_irish_med_j_mcc…“>http://www.indymedia.ie/attachments/may2020/covid-19_vit_d_irish_med_j_mcc… – PubMed
- Marik P.E. Vitamin C: an essential “stress hormone” during sepsis. J Thorac Dis. February 2020;12(Supplement 1) http://jtd.amegroups.com/article/view/34870/html” rel=”noopener nofollow noopener” title=”External link: http://jtd.amegroups.com/article/view/34870/html“>http://jtd.amegroups.com/article/view/34870/html (Sepsis: Science and Fiction) – PMC – PubMed