Objective: Because of the effect of vitamins on modulating the immune system function, we have evaluated the effect of supplementation with vitamin A, B, C, D, and E in ICU-admitted patients with COVID-19. Methods: This study was a randomized and single-blinded clinical trial in which 60 subjects were randomly assigned to two groups. The intervention group (n=30) received vitamins and control group did not receive any vitamin or placebo. The intervention was included of 25,000 IU daily of vitamins A, 600,000 IU once during the study of D, 300 IU twice daily of 3 E, 500 mg four times daily of C, and one amp daily of B complex for seven days. At baseline and after 7-day intervention, the serum levels of inflammatory markers, vitamins, and the SOFA score were assessed. In addition, the mortality rate and duration of hospitalization were evaluated after intervention. (IRCT registration number: IRCT20200319046819N1/ Registration date: 2020-04-04, https://www.irct.ir/trial/46838 )
Results: Significant changes were detected in serum levels of vitamins (p< 0.001 for all vitamins), ESR (p< 0.001), CRP (p= 0.001), IL6 (p= 0.003), TNF-a (p= 0.001) and SOFA score (p< 0.001) after intervention compared with the control group. The effect of vitamins on the mortality rate was not statistically significant (p=0.112). The prolonged hospitalization rate to more than 7 days was significantly lower in the intervention group than the control group (p=0.001). Regarding the effect size, there was a significant and inverse association between receiving intervention and prolonged hospitalization (OR=0.135, 95% CI: 0.038–0.481; p=0.002); however, after adjusting for confounders, it was not significant (OR=0.402, 95% CI: 0.086–1.883; p=0.247).
Conclusion: Supplementation with vitamin A, B, C, D, and E could improve the inflammatory response and decrease the severity of disease in ICU-admitted patients with COVID-19.
Keywords: COVID-19, Vitamin, Supplementation, SOFA, Inflammation, Cytokine
Abbreviations: Intensive-care unit (ICU), Oxygen (O 2 ), Coronavirus 19 (COVID-19), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), Interferon-Gamma (IFN-g), Tumor Necrosis Factor-Alpha (TNF-a), Interleukin-6 (IL-6), Acute Physiologic Assessment and Chronic Health Evaluation (APACHE score), Computed Tomography Scan (CT scan), Sequential Organ Failure Assessment (SOFA), Body mass index (BMI), Complete Blood Cell Count and Differential Count (CBC-diff), Effect Size (ES)