Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection

The Journal of Clinical Endocrinology and Metabolism
Q1
Oct 2020
Citations:248
Influential Citations:14
Observational Studies (Human)
83
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Enhanced Details

Methods
Retrospective case-control design. Participants: 216 adults (≥18) with confirmed COVID-19 admitted to University Hospital Marqués de Valdecilla, Santander, Spain, March 10–31, 2020; 197 sex-matched population-based controls from the Camargo Cohort. Exclusions: malabsorption disorders, liver cirrhosis, serum creatinine >1.9 mg/dL, prior anticonvulsants. Two-part analysis: (1) compare serum 25OHD between groups; (2) in COVID-19 patients, assess association between vitamin D status and severity endpoints (ICU admission, mechanical ventilation, in-hospital mortality).
Intervention
Oral vitamin D supplements: cholecalciferol 25,000 IU monthly (10 patients); cholecalciferol 5,600 IU weekly (1 patient); calcifediol 0.266 mg monthly (8 patients); duration >3 months prior to admission.
Results
Serum 25OHD was lower in hospitalized COVID-19 patients (13.8 ± 7.2 ng/mL) than in controls (20.9 ± 7.4 ng/mL; P<0.0001). Vitamin D deficiency (<20 ng/mL) occurred in 82.2% of cases vs 47.2% of controls (P<0.0001). 25OHD inversely correlated with ferritin (P=0.013) and D-dimer (P=0.027). Vitamin D-deficient patients had more hypertension and cardiovascular disease, higher ferritin and troponin, and longer hospital stay than those with 25OHD ≥20 ng/mL. No causal link between vitamin D deficiency or levels and severity/mortality of COVID-19 after adjustments; power for severity endpoints was limited. Among 19 supplemented patients, outcomes tended toward better oxygenation (higher PaO2/FiO2), lower ferritin, less tocilizumab use, and shorter stay, though differences varied by measure. Pooling data show higher 25OHD (≥20 ng/mL) associated with some improved metrics (lower ICU admissions, shorter stay) but no difference in composite severity endpoint or mortality. Raising 25OHD above 20 ng/mL could benefit musculoskeletal and immune health; large randomized trials are needed to determine whether supplementation improves COVID-19 outcomes.
Limitations
Observational, retrospective, single-center study; cannot establish causality; small vitamin D supplement subgroup with variable dosages; not all vitamin D-related parameters measured; different 25OHD assays used for cases and controls; no dietary assessment; data not imputed; limited power for severity endpoints.

Abstract

Abstract Background The role of vitamin D status in COVID-19 patients is a matter of debate. Objectives To assess serum 25-hydroxyvitamin D (25OHD) levels in hospitalized patients with COVID-19 and to analyze the possible influence of vitamin D statu...