This retrospective study investigated time-dependent changes in vitamin D levels and their correlation with disease severity and inflammation in 24 invasively mechanically ventilated patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO), predominantly suffering from severe COVID-19 (79%).

The study utilized a longitudinal approach, analyzing serial blood samples for 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) levels over 17 days.

Results showed a high prevalence of hypovitaminosis D (75% with 25(OH)D ≤ 50 nmol/L) and severe deficiency (21% with 25(OH)D < 30 nmol/L) upon admission. While 25(OH)D levels remained largely stable during the observation period, 1,25(OH)2D levels significantly decreased by 28% within the first 11 days (p = 0.03) before stabilizing. A significant negative correlation was observed between 25(OH)D and C-reactive protein (CRP), an inflammatory marker (p = 0.04), but neither vitamin D form correlated with disease severity. The study concluded that patients with severe COVID-19 ARDS treated with ECMO exhibit a significant decline in 1,25(OH)2D levels. Given the high prevalence of hypovitaminosis D and the potential association between vitamin D and inflammation, the authors recommend routine vitamin D substitution and monitoring in this critically ill population to prevent deficiencies and highlight the need for further research to understand these observed dynamics.

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