Vitamin A Plasma Levels in COVID-19 Patients: A Prospective Multicenter Study and Hypothesis |
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Authors: | Phil-Robin Tepasse,Richard Vollenberg,Manfred Fobker,Iyad Kabar,Hartmut Schmidt,Jö rn Arne Meier,Tobias Nowacki,Anna Hü sing-Kabar |
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Affiliation: | 1.Department of Medicine B for Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Muenster, 48149 Muenster, Germany; (R.V.); (I.K.); (H.S.); (J.A.M.); (T.N.); (A.H.-K.);2.Center for Laboratory Medicine, University Hospital Muenster, 48149 Muenster, Germany; |
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Abstract: | COVID-19 is a pandemic disease that causes severe pulmonary damage and hyperinflammation. Vitamin A is a crucial factor in the development of immune functions and is known to be reduced in cases of acute inflammation. This prospective, multicenter observational cross-sectional study analyzed vitamin A plasma levels in SARS-CoV-2 infected individuals, and 40 hospitalized patients were included. Of these, 22 developed critical disease (Acute Respiratory Distress Syndrome [ARDS]/Extracorporeal membrane oxygenation [ECMO]), 9 developed severe disease (oxygen supplementation), and 9 developed moderate disease (no oxygen supplementation). A total of 47 age-matched convalescent persons that had been earlier infected with SARS-CoV-2 were included as the control group. Vitamin A plasma levels were determined by high-performance liquid chromatography. Reduced vitamin A plasma levels correlated significantly with increased levels of inflammatory markers (CRP, ferritin) and with markers of acute SARS-CoV-2 infection (reduced lymphocyte count, LDH). Vitamin A levels were significantly lower in hospitalized patients than in convalescent persons (p < 0.01). Of the hospitalized patients, those who were critically ill showed significantly lower vitamin A levels than those who were moderately ill (p < 0.05). Vitamin A plasma levels below 0.2 mg/L were significantly associated with the development of ARDS (OR = 5.54 [1.01–30.26]; p = 0.048) and mortality (OR 5.21 [1.06–25.5], p = 0.042). Taken together, we conclude that vitamin A plasma levels in COVID-19 patients are reduced during acute inflammation and that severely reduced plasma levels of vitamin A are significantly associated with ARDS and mortality. |
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Keywords: | COVID-19 vitamin A retinol retinoic acid ARDS pneumonia pandemic SARS-CoV-2 inflammation |
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