Baseline serum vitamin A and vitamin C levels and their association with disease severity in COVID-19 patients Serum Vitamin A and C levels and COVID-19 severity

Main Article Content

Gulseren Yilmaz
Huri Bulut
Derya Ozden Omaygenc
Aysu Akca
Esra Can
Nevin Tuten
Aysegul Bestel
Baki Erdem
Uygar Ozan Atmaca
Yasin Kara
Ebru Kaya
Murat Unsel
Ayca Sultan Sahin
Ziya Salihoglu


Ascorbic acid, COVID-19, Hospital stay, Pulmonary disease, Vitamin A


Aim: We aimed to investigate the association between the serum concentrations of Vitamin A and Vitamin C and the severity of the COVID-19. 

Methods: Fifty-three consecutive PCR (+) COVID-19 patients admitted to a dedicated ward were enrolled in this study. Blood samples for serum Vitamin A and C measurements were drawn from all participants upon admission. All subjects underwent thoracic CT imaging prior to hospitalization. CT severity score (CT-SS) was then calculated for determining the extent of pulmonary involvement. A group of healthy volunteers, in whom COVID-19 was ruled out, were assigned to the control group (n=26). These groups were compared by demographic features and serum vitamin A and C levels. The relationship between serum concentrations of these vitamins and pre-defined outcome measures, CT-SS and length of hospitalization (LOH), was also assessed. 

Results: In COVID-19 patients, serum Vitamin A (ng/ml, 494±96 vs. 698±93; p<0.001) and Vitamin C (ng/ml, 2961 [1991-31718] vs. 3953 [1385-8779]; p=0.007) levels were significantly lower with respect to healthy controls. According to the results of correlation analyses, there was a significant negative association between Vitamin A level and outcome measures (LOH, r=-0.293; p=0.009 and CT-SS, r=-0.289; p=0.010). The negative correlations between Vitamin C level and those measures were even more prominent (LOH, r=-0.478; p<0.001 and CT-SS, r=-0.734: p<0.001).

Conclusion: COVID-19 patients had lower baseline serum Vitamin A and Vitamin C levels as compared to healthy controls. In subjects with COVID-19, Vitamin A and Vitamin C levels were negatively correlated with CT-SS and LOH.


Download data is not yet available.
Abstract 204 | PDF Downloads 126


1. Jamal M, Bangash HI, Habiba M, et al. Immune dysregulation and system pathology in COVID-19. Virulence. 2021; 12(1):918-36. doi: 10.1080/21505594.2021.1898790.
2. Odegaard JI, Chawla A. Connecting type 1 and type 2 diabetes through innate immunity. Cold Spring Harb Perspect Med. 2012; 2(3):a007724. doi: 10.1101/cshperspect.a007724.
3. Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020; 20(6):363-74. doi: 10.1038/s41577-020-0311-8.
4. Farjana M, Moni A, Sohag AAM, et al. Repositioning Vitamin C as a Promising Option to Alleviate Complications associated with COVID-19. Infect Chemother. 2020 Dec;52(4):461-77. doi: 10.3947/ic.2020.52.4.461.
5. Murni IK, Prawirohartono EP, Triasih R. Potential Role of Vitamins and Zinc on Acute Respiratory Infections Including Covid-19. Glob Pediatr Health. 2021; 8:2333794X211021739. doi: 10.1177/2333794X211021739.
6. Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, et al. Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19. Radiol Cardiothorac Imaging. 2020; 2(2):e200047. doi: 10.1148/ryct.2020200047.
7. Tian J, Yuan X, Xiao J, et al. Clinical characteristics and risk factors associated with COVID-19 disease severity in patients with cancer in Wuhan, China: a multicentre, retrospective, cohort study. Lancet Oncol. 2020; 21(7):893-903. doi: 10.1016/S1470-2045(20)30309-0.
8. Pereira MR, Mohan S, Cohen DJ, et al. COVID-19 in solid organ transplant recipients: Initial report from the US epicenter. Am J Transplant. 2020; 20(7):1800-8. doi: 10.1111/ajt.15941.
9. Pecoraro A, Crescenzi L, Galdiero MR, et al. Immunosuppressive therapy with rituximab in common variable immunodeficiency. Clin Mol Allergy. 2019; 17:9. doi: 10.1186/s12948-019-0113-3.
10. Shiau S, Krause KD, Valera P, Swaminathan S, Halkitis PN. The Burden of COVID-19 in People Living with HIV: A Syndemic Perspective. AIDS Behav. 2020; 24(8):2244-9. doi: 10.1007/s10461-020-02871-9.
11. Riva A, Conti F, Bernacchia D, et al. Darunavir does not prevent SARS-CoV-2 infection in HIV patients. Pharmacol Res. 2020; 157:104826. doi: 10.1016/j.phrs.2020.104826.
12. McCullough FS, Northrop-Clewes CA, Thurnham DI. The effect of vitamin A on epithelial integrity. Proc Nutr Soc. 1999; 58(2):289-93. doi: 10.1017/s0029665199000403.
13. Wang JL, Swartz-Basile DA, Rubin DC, Levin MS. Retinoic acid stimulates early cellular proliferation in the adapting remnant rat small intestine after partial resection. J Nutr. 1997; 127(7):1297-303. doi: 10.1093/jn/127.7.1297.
14. Qi YJ, Niu QL, Zhu XL, Zhao XZ, Yang WW, Wang XJ. Relationship between deficiencies in vitamin A and E and occurrence of infectious diseases among children. Eur Rev Med Pharmacol Sci. 2016; 20(23):5009-12.
15. Kiss I, Rühl R, Szegezdi E, et al. Retinoid receptor-activating ligands are produced within the mouse thymus during postnatal development. Eur J Immunol. 2008; 38(1):147-55. doi: 10.1002/eji.200737342.
16. Kuwata T, Wang IM, Tamura T, et al. Vitamin A deficiency in mice causes a systemic expansion of myeloid cells. Blood. 2000; 95(11):3349-56.
17. van Bennekum AM, Wong Yen Kong LR, Gijbels MJ, et al. Mitogen response of B cells, but not T cells, is impaired in adult vitamin A-deficient rats. J Nutr. 1991; 121(12):1960-8. doi: 10.1093/jn/121.12.1960.
18. Mohammed BM, Fisher BJ, Kraskauskas D, et al. Vitamin C promotes wound healing through novel pleiotropic mechanisms. Int Wound J. 2016; 13(4):572-84. doi: 10.1111/iwj.12484.
19. Fisher BJ, Kraskauskas D, Martin EJ, et al. Mechanisms of attenuation of abdominal sepsis induced acute lung injury by ascorbic acid. Am J Physiol Lung Cell Mol Physiol. 2012; 303(1): L20-32. doi: 10.1152/ajplung.00300.2011.
20. Jimenez MF, Watson RW, Parodo J, et al. Dysregulated expression of neutrophil apoptosis in the systemic inflammatory response syndrome. Arch Surg. 1997; 132(12):1263-9; doi: 10.1001/archsurg.1997.01430360009002.
21. Demaret J, Venet F, Friggeri A, et al. Marked alterations of neutrophil functions during sepsis-induced immunosuppression. J Leukoc Biol. 2015; 98(6):1081-90. doi: 10.1189/jlb.4A0415-168RR.
22. Arraes SM, Freitas MS, da Silva SV, de Paula Neto HA, Alves-Filho JC, Auxiliadora Martins M, et al. Impaired neutrophil chemotaxis in sepsis associates with GRK expression and inhibition of actin assembly and tyrosine phosphorylation. Blood. 2006; 108(9):2906-13. doi: 10.1182/blood-2006-05-024638.
23. Heuser G, Vojdani A. Enhancement of natural killer cell activity and T and B cell function by buffered vitamin C in patients exposed to toxic chemicals: the role of protein kinase-C. Immunopharmacol Immunotoxicol. 1997; 19(3):291-312. doi: 10.3109/08923979709046977.
24. Kim Y, Kim H, Bae S, et al. Vitamin C Is an Essential Factor on the Anti-viral Immune Responses through the Production of Interferon-α/β at the Initial Stage of Influenza A Virus (H3N2) Infection. Immune Netw. 2013; 13(2):70-4. doi: 10.4110/in.2013.13.2.70.
25. Mochalkin NI. Askorbinovaia kislota v kompleksnoĭ terapii bol'nykh ostroĭ pnevmonieĭ [Ascorbic acid in the complex therapy of acute pneumonia]. Voen Med Zh. 1970; 9:17-21. Russian.
26. Hunt C, Chakravorty NK, Annan G, Habibzadeh N, Schorah CJ. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int J Vitam Nutr Res. 1994; 64(3):212-9.
27. Li R, Wu K, Li Y, et al. Revealing the targets and mechanisms of vitamin A in the treatment of COVID-19. Aging (Albany NY). 2020; 12(15):15784-96. doi: 10.18632/aging.103888.
28. Stephensen CB, Lietz G. Vitamin A in resistance to and recovery from infection: relevance to SARS-CoV2. Br J Nutr. 2021; 126(11):1663-72. doi: 10.1017/S0007114521000246.
29. Coppock D, Violet PC, Vasquez G, et al. Pharmacologic Ascorbic Acid as Early Therapy for Hospitalized Patients with COVID-19: A Randomized Clinical Trial. Life (Basel). 2022; 12(3):453. doi: 10.3390/life12030453.
30. Al Sulaiman K, Aljuhani O, Saleh KB, et al. Ascorbic acid as an adjunctive therapy in critically ill patients with COVID-19: a propensity score matched study. Sci Rep. 2021; 11(1):17648. doi: 10.1038/s41598-021-96703-y.