An investigation into the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital

Thumeka P. Jalavu; Lovemore N. Sigwadhi; Maritha J. Kotze; Anteneh Yalew; Vera Ngah; Jacques L. Tamuzi; Zivanai C. Chapanduka; Brian W. Allwood; Coenraad F. Koegelenberg; Elvis M. Irusen; Usha Lalla; Tandi E. Matsha; Rajiv T. Erasmus; Alimmudin Zumla; Annalise E. Zemlin; Peter S. Nyasulu

doi:10.1016/j.ijregi.2023.05.007

An investigation into the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital

Thumeka P. Jalavu, Lovemore N. Sigwadhi, Maritha J. Kotze, Anteneh Yalew, Vera Ngah, Jacques L. Tamuzi, Zivanai C. Chapanduka, Brian W. Allwood, Coenraad F. Koegelenberg, Elvis M. Irusen, Usha Lalla, Tandi E. Matsha, Rajiv T. Erasmus, Alimmudin Zumla, Annalise E. Zemlin, Peter S. Nyasulu^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Severe coronavirus disease 2019 (COVID-19) has a poor prognosis, and biomarkers may predict disease severity. The aim of this study was to assess the effect of baseline vitamin D (VitD) inadequacy on the outcomes of patients with severe COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital in South Africa. Methods: Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited during wave II of the pandemic in Cape Town. Eighty-six patients were included in the study. They were categorized into three groups: VitD deficient, VitD insufficient, and VitD sufficient. The VitD deficient and VitD insufficient groups were combined to form a ‘VitD inadequate’ group. Cox regression analysis was done to assess the association between VitD status and mortality. Factors with P < 0.05 in the adjusted multivariable Cox regression analysis were considered statistically significant. Results: The proportion of VitD inadequacy was 64% (55/86); this group had a significantly higher proportion with hypertension (66%; P = 0.012). The Kaplan–Meier curve showed no significant difference in the probability of survival among the COVID-19 patients admitted to the ICU with or without VitD inadequacy. However, patients with elevated serum creatinine were significantly more at risk of dying (adjusted hazard ratio 1.008, 95% confidence interval 1.002–1.030; P = 0.017). Conclusions: This study found a high prevalence of VitD inadequacy (combined deficiency and insufficiency) in COVID-19 patients admitted to the ICU. This may indicate a possible risk of severe disease. Whilst there was no statistically significant relationship between VitD status and mortality in this cohort, baseline VitD may be an important prognostic biomarker in COVID-19 patients admitted to the ICU, particularly in those with comorbidities that predispose to VitD deficiency.

Original language	English
Pages (from-to)	121-128
Number of pages	8
Journal	IJID Regions
Volume	8
DOIs	https://doi.org/10.1016/j.ijregi.2023.05.007
Publication status	Published - Sept 2023
Externally published	Yes

Keywords

COVID-19
ICU
Outcomes
Prognosis
Vitamin D

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ijregi.2023.05.007

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Jalavu, T. P., Sigwadhi, L. N., Kotze, M. J., Yalew, A., Ngah, V., Tamuzi, J. L., Chapanduka, Z. C., Allwood, B. W., Koegelenberg, C. F., Irusen, E. M., Lalla, U., Matsha, T. E., Erasmus, R. T., Zumla, A., Zemlin, A. E., & Nyasulu, P. S. (2023). An investigation into the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital. IJID Regions, 8, 121-128. https://doi.org/10.1016/j.ijregi.2023.05.007

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title = "An investigation into the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital",

abstract = "Background: Severe coronavirus disease 2019 (COVID-19) has a poor prognosis, and biomarkers may predict disease severity. The aim of this study was to assess the effect of baseline vitamin D (VitD) inadequacy on the outcomes of patients with severe COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital in South Africa. Methods: Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited during wave II of the pandemic in Cape Town. Eighty-six patients were included in the study. They were categorized into three groups: VitD deficient, VitD insufficient, and VitD sufficient. The VitD deficient and VitD insufficient groups were combined to form a {\textquoteleft}VitD inadequate{\textquoteright} group. Cox regression analysis was done to assess the association between VitD status and mortality. Factors with P < 0.05 in the adjusted multivariable Cox regression analysis were considered statistically significant. Results: The proportion of VitD inadequacy was 64% (55/86); this group had a significantly higher proportion with hypertension (66%; P = 0.012). The Kaplan–Meier curve showed no significant difference in the probability of survival among the COVID-19 patients admitted to the ICU with or without VitD inadequacy. However, patients with elevated serum creatinine were significantly more at risk of dying (adjusted hazard ratio 1.008, 95% confidence interval 1.002–1.030; P = 0.017). Conclusions: This study found a high prevalence of VitD inadequacy (combined deficiency and insufficiency) in COVID-19 patients admitted to the ICU. This may indicate a possible risk of severe disease. Whilst there was no statistically significant relationship between VitD status and mortality in this cohort, baseline VitD may be an important prognostic biomarker in COVID-19 patients admitted to the ICU, particularly in those with comorbidities that predispose to VitD deficiency.",

keywords = "COVID-19, ICU, Outcomes, Prognosis, Vitamin D",

author = "Jalavu, {Thumeka P.} and Sigwadhi, {Lovemore N.} and Kotze, {Maritha J.} and Anteneh Yalew and Vera Ngah and Tamuzi, {Jacques L.} and Chapanduka, {Zivanai C.} and Allwood, {Brian W.} and Koegelenberg, {Coenraad F.} and Irusen, {Elvis M.} and Usha Lalla and Matsha, {Tandi E.} and Erasmus, {Rajiv T.} and Alimmudin Zumla and Zemlin, {Annalise E.} and Nyasulu, {Peter S.}",

note = "Funding Information: Research funding: This work was conducted with funding from the COVID-19 Africa Rapid Grant Fund supported under the auspices of the Science Granting Councils Initiative in Sub-Saharan Africa (SGCI) and administered by South Africa's National Research Foundation (NRF) in collaboration with Canada's International Development Research Centre (IDRC), and the National Health Laboratory Service (NHLS). Funding Information: Sir Alimuddin Zumla is co-principal investigator of The Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET, CANTAM-3, and EACCR-3) funded by the European and Developing Countries Clinical Trials Partnership, the EU Horizon 2020 Framework Programme. Sir Alimuddin Zumla is in receipt of a UK-NIHR Senior Investigator award. He is also a Mahathir Science Award and EU-EDCTP Pascoal Mocumbi Prize Laureate. Research funding: This work was conducted with funding from the COVID-19 Africa Rapid Grant Fund supported under the auspices of the Science Granting Councils Initiative in Sub-Saharan Africa (SGCI) and administered by South Africa's National Research Foundation (NRF) in collaboration with Canada's International Development Research Centre (IDRC), and the National Health Laboratory Service (NHLS). Informed consent statement: The investigators obtained ethical approval and a waiver of consent from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and the Research Ethics Committee of Tygerberg Hospital (approval number N20/04/002_COVID-19). Conflict of interest: No conflict of interest declared. Funding Information: Sir Alimuddin Zumla is co-principal investigator of The Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET, CANTAM-3, and EACCR-3) funded by the European and Developing Countries Clinical Trials Partnership, the EU Horizon 2020 Framework Programme. Sir Alimuddin Zumla is in receipt of a UK-NIHR Senior Investigator award. He is also a Mahathir Science Award and EU-EDCTP Pascoal Mocumbi Prize Laureate. Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = sep,

doi = "10.1016/j.ijregi.2023.05.007",

language = "English",

volume = "8",

pages = "121--128",

journal = "IJID Regions",

issn = "2772-7076",

}

Jalavu, TP, Sigwadhi, LN, Kotze, MJ, Yalew, A, Ngah, V, Tamuzi, JL, Chapanduka, ZC, Allwood, BW, Koegelenberg, CF, Irusen, EM, Lalla, U, Matsha, TE, Erasmus, RT, Zumla, A, Zemlin, AE & Nyasulu, PS 2023, 'An investigation into the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital', IJID Regions, vol. 8, pp. 121-128. https://doi.org/10.1016/j.ijregi.2023.05.007

TY - JOUR

T1 - An investigation into the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital

AU - Jalavu, Thumeka P.

AU - Sigwadhi, Lovemore N.

AU - Kotze, Maritha J.

AU - Yalew, Anteneh

AU - Ngah, Vera

AU - Tamuzi, Jacques L.

AU - Chapanduka, Zivanai C.

AU - Allwood, Brian W.

AU - Koegelenberg, Coenraad F.

AU - Irusen, Elvis M.

AU - Lalla, Usha

AU - Matsha, Tandi E.

AU - Erasmus, Rajiv T.

AU - Zumla, Alimmudin

AU - Zemlin, Annalise E.

AU - Nyasulu, Peter S.

N1 - Funding Information: Research funding: This work was conducted with funding from the COVID-19 Africa Rapid Grant Fund supported under the auspices of the Science Granting Councils Initiative in Sub-Saharan Africa (SGCI) and administered by South Africa's National Research Foundation (NRF) in collaboration with Canada's International Development Research Centre (IDRC), and the National Health Laboratory Service (NHLS). Funding Information: Sir Alimuddin Zumla is co-principal investigator of The Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET, CANTAM-3, and EACCR-3) funded by the European and Developing Countries Clinical Trials Partnership, the EU Horizon 2020 Framework Programme. Sir Alimuddin Zumla is in receipt of a UK-NIHR Senior Investigator award. He is also a Mahathir Science Award and EU-EDCTP Pascoal Mocumbi Prize Laureate. Research funding: This work was conducted with funding from the COVID-19 Africa Rapid Grant Fund supported under the auspices of the Science Granting Councils Initiative in Sub-Saharan Africa (SGCI) and administered by South Africa's National Research Foundation (NRF) in collaboration with Canada's International Development Research Centre (IDRC), and the National Health Laboratory Service (NHLS). Informed consent statement: The investigators obtained ethical approval and a waiver of consent from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and the Research Ethics Committee of Tygerberg Hospital (approval number N20/04/002_COVID-19). Conflict of interest: No conflict of interest declared. Funding Information: Sir Alimuddin Zumla is co-principal investigator of The Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET, CANTAM-3, and EACCR-3) funded by the European and Developing Countries Clinical Trials Partnership, the EU Horizon 2020 Framework Programme. Sir Alimuddin Zumla is in receipt of a UK-NIHR Senior Investigator award. He is also a Mahathir Science Award and EU-EDCTP Pascoal Mocumbi Prize Laureate. Publisher Copyright: © 2023

PY - 2023/9

Y1 - 2023/9

N2 - Background: Severe coronavirus disease 2019 (COVID-19) has a poor prognosis, and biomarkers may predict disease severity. The aim of this study was to assess the effect of baseline vitamin D (VitD) inadequacy on the outcomes of patients with severe COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital in South Africa. Methods: Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited during wave II of the pandemic in Cape Town. Eighty-six patients were included in the study. They were categorized into three groups: VitD deficient, VitD insufficient, and VitD sufficient. The VitD deficient and VitD insufficient groups were combined to form a ‘VitD inadequate’ group. Cox regression analysis was done to assess the association between VitD status and mortality. Factors with P < 0.05 in the adjusted multivariable Cox regression analysis were considered statistically significant. Results: The proportion of VitD inadequacy was 64% (55/86); this group had a significantly higher proportion with hypertension (66%; P = 0.012). The Kaplan–Meier curve showed no significant difference in the probability of survival among the COVID-19 patients admitted to the ICU with or without VitD inadequacy. However, patients with elevated serum creatinine were significantly more at risk of dying (adjusted hazard ratio 1.008, 95% confidence interval 1.002–1.030; P = 0.017). Conclusions: This study found a high prevalence of VitD inadequacy (combined deficiency and insufficiency) in COVID-19 patients admitted to the ICU. This may indicate a possible risk of severe disease. Whilst there was no statistically significant relationship between VitD status and mortality in this cohort, baseline VitD may be an important prognostic biomarker in COVID-19 patients admitted to the ICU, particularly in those with comorbidities that predispose to VitD deficiency.

AB - Background: Severe coronavirus disease 2019 (COVID-19) has a poor prognosis, and biomarkers may predict disease severity. The aim of this study was to assess the effect of baseline vitamin D (VitD) inadequacy on the outcomes of patients with severe COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital in South Africa. Methods: Patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited during wave II of the pandemic in Cape Town. Eighty-six patients were included in the study. They were categorized into three groups: VitD deficient, VitD insufficient, and VitD sufficient. The VitD deficient and VitD insufficient groups were combined to form a ‘VitD inadequate’ group. Cox regression analysis was done to assess the association between VitD status and mortality. Factors with P < 0.05 in the adjusted multivariable Cox regression analysis were considered statistically significant. Results: The proportion of VitD inadequacy was 64% (55/86); this group had a significantly higher proportion with hypertension (66%; P = 0.012). The Kaplan–Meier curve showed no significant difference in the probability of survival among the COVID-19 patients admitted to the ICU with or without VitD inadequacy. However, patients with elevated serum creatinine were significantly more at risk of dying (adjusted hazard ratio 1.008, 95% confidence interval 1.002–1.030; P = 0.017). Conclusions: This study found a high prevalence of VitD inadequacy (combined deficiency and insufficiency) in COVID-19 patients admitted to the ICU. This may indicate a possible risk of severe disease. Whilst there was no statistically significant relationship between VitD status and mortality in this cohort, baseline VitD may be an important prognostic biomarker in COVID-19 patients admitted to the ICU, particularly in those with comorbidities that predispose to VitD deficiency.

KW - COVID-19

KW - ICU

KW - Outcomes

KW - Prognosis

KW - Vitamin D

UR - http://www.scopus.com/inward/record.url?scp=85168000847&partnerID=8YFLogxK

U2 - 10.1016/j.ijregi.2023.05.007

DO - 10.1016/j.ijregi.2023.05.007

M3 - Article

C2 - 37363198

AN - SCOPUS:85168000847

SN - 2772-7076

VL - 8

SP - 121

EP - 128

JO - IJID Regions

JF - IJID Regions

ER -

An investigation into the correlation of vitamin D status and management outcomes in patients with severe COVID-19 at a South African tertiary hospital

Abstract

Keywords

UN SDGs

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