A combined  role for low vitamin D and low albumin circulating levels as strong predictors  of worse outcome in COVID-19 patients.

The measurement of both vitamin D and serum albumin on COVID-19 patients’ admission, and their combined evaluation, could provide a relatively simple prognostic evaluation that clinicians could take into account along with other factors to determine treatment course but more research is needed.

• No correlation between vitamin D and albumin levels was found.  
• In multivariable logistic regression analyses adjusted for sex and age-corrected comorbidities, patients having albumin < 3.5 g/dL and vitamin D < 30 ng/mL showed a significant increased risk for all negative study outcomes.

Sixty-nine patients were enrolled, of whom 50% received non-invasive (NIV) or invasive mechanical ventilation (IMV), 10% died, whereas 89% and 66% presented low albumin and low vitamin D serum levels, respectively.

• This study had a small sample size; therefore, the number of potential covariates in the multivariate analysis was limited to three, potentially excluding possible other significant independent predictors of disease severity.  
• Systemic inflammation may reduce vitamin D concentrations, due to variations in the concentrations of vitamin D-binding protein and/or modulation of vitamin D metabolism, this prevents identification of a cause/consequence relationship between vitamin D concentrations and COVID-19 severity. 

“In conclusion, the measurement of both vitamin D and serum albumin on COVID-19 patients’ admission, and their combined evaluation, could provide a relatively simple prognostic evaluation that clinicians could take into account (alongside with other multiparametric prognostic scores) both for taking pragmatic decisions and to think over the underlying complex pathophysiological mechanisms that relate vitamin D and albumin depletion with a worse outcome.” 

• An observational, prospective, longitudinal study enrolling adults (aged > 18 years) with SARS-CoV-2 pneumonia which has been admitted to the Infectious Diseases Unit of Trieste University Hospital, Italy, from March to September 2020.  
• Vitamin D and albumin serum levels were measured on admission.  
• These variables were categorized in albumin < 3.5 or ≥ 3.5 g/dL and vitamin D < 30 ng/mL or ≥ 30 ng/mL.  
• Patients with known bone diseases, renal failure, hypercalcemia and/or treated with antiepileptic drugs and steroids, and patients who received previous vitamin D supplementation were excluded.  
• A composite outcome including any ventilatory support, PaO2/FiO2 ratio, and 60-day mortality was defined. 

Sanson G, De Nicolò A, Zerbato V, Segat L, Koncan R, Di Bella S, Cusato J, di Masi A, Palermo A, Caironi P, D’Agaro P, Luzzati R, D’Avolio A. A combined role for low vitamin D and low albumin circulating levels as strong predictors of worse outcome in COVID-19 patients. Ir J Med Sci. 2022 Feb 19:1–8. doi: 10.1007/s11845-022-02952-9. Epub ahead of print. PMID: 35182287; PMCID: PMC8857533.