Effects of Spirulina platensis Supplementation on COVID-19 Severity in Critically Ill Patients: A Randomized Clinical Trial

Background: Spirulina is a functional food with antioxidant and anti-inflammatory properties. Its anti-inflammatory, antioxidant, antiviral, and immunomodulatory potential may improve certain clinical conditions in patients with coronavirus disease 2019 (COVID-19) in the intensive care unit (ICU). Objectives: This study aimed to investigate the effects of Spirulina supplementation on clinical conditions in critically ill patients with COVID-19. Methods: A double-blind clinical trial randomized patients admitted to an ICU to receive either Spirulina platensis supplementation (5g/day, n = 97) or to a control group (n = 95). The severity of COVID-19 was assessed using the Acute Physiology and Chronic Health Evaluation (APACHE), National Early Warning Score (NEWS) 2, and Sequential Organ Failure Assessment Score (SOFA). The study also evaluated the length of stay in the hospital and ICU, respiratory support at discharge, and 28-day mortality. In the survival analysis, 126 participants were evaluated (58 in the control group and 68 in the Spirulina group). Results: There was no significant difference between the groups in 28-day mortality (HR = 1.07, 95% CI 0.57 - 1.97) or NEWS2 (P = 0.76). However, the SOFA score significantly decreased in the Spirulina group compared to the control group (P = 0.03). The Spirulina group had a shorter ICU length of stay (7.43 ± 3.98 days) compared to the control group (10.00 ± 4.69 days, P = 0.007). The hospital length of stay was also shorter in the Spirulina group compared to the control group (P = 0.001). Conclusions: Spirulina supplementation reduced disease severity (as measured by the SOFA score) and shortened hospital and ICU length of stay in critically ill COVID-19 patients, but it did not reduce mortality.