An Evaluation of Serum 25-Hydroxy Vitamin D Levels
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An Evaluation of Serum 25-Hydroxy Vitamin D Levels in Patients with COVID-19 in New York City
Take Home Message
After adjustingfor demographic variables and comorbidities, this retrospective analysis of COVID-positive patients in New York City, showsa significant association betweenlow 25(OH)D levels and an increased likelihood of need for oxygensupport.
Four-hundred thirty-seven adult COVID-19 patients within the Mount Sinai HealthSystem (New York City ) who had serum 25-hydroxy vitamin D levels [25(OH)D] drawnwithin the three months preceding their COVID-19diagnosis.
Length of Study
Between March 1, 2020 and May 8, 2020
Included in the study were 437 COVID-19 positive patients with 25(OH)D measurements recorded in the prior 3 months.
The overall population was older[median, 67 years; range, 56-79 years] with 52% (227/437) women and the main comorbidities beinghypertension (68%), diabetes (45%), coronary artery disease(30%) and malignancy (24%).
There were 177 patients classifiedas vitamin D deficient (<50 nmol/L) compared to 260 patients whowere vitamin D sufficient (³50 nmol/L). Moremales were vitamin D deficient compared to vitamin Dsufficient (97, 55% vs 113, 43%, p.0.02) as werepatients with chronic kidney disease (49, 28% vs44, 17%, p.0.008).
Deficientplasma 25(OH)D levels (<20 ng/ml) were associated with an increased likelihood of oxygensupport [OR:2.23 (95% CI: 1.46–3.44, p.0.0002)] from COVID-19 when demographic variables and comorbidities were considered.
Deficient plasma 25(OH)D levelswere not independently associated with 90-day mortality or risk of hospitalization.
Hospitalizationrates (98%), oxygen support (93%) and mortality rates (49%) were highest in patients who had25(OH)D levels less than 10 ng/ml when compared to other 25(OH)D levels.
Things to Keep in Mind
Several demographic variables were not assessed and therefore notcontrolled, including nursing home residency orbed bound status; socioeconomic status; and genotype and/or condition that impairs vitaminD metabolism such as medication, malnutritionor bariatric surgery.
This study was retrospectivein nature.
There was no comparison to healthypatients who did not have COVID-19 disease, but also hadserum 25(OH)D levels. Therefore, it is unknown the protectivebenefits vitamin D has on obtaining the disease.
Intensive care unit(ICU) admission was not evaluated, as this data point was difficult to gather asmany of the medical center’s medicine wards became ICUs during the pandemic.
The authors did not set mortality at 15-day mortality or 30-day mortality due to the small sample size, and theextended hospital stays the patients were experiencing at the medical center. The addition of patient data from the second wave of COVID-19 infections seen during Fall 2020 would increase the sample size and robustness of the data set.
There is no consensus on the cutoff of vitamin Dsufficiency. The Institute of Medicine (IOM) defines vitamin Ddeficiency as serum 25(OH)D<50 nmol/L, yet manystudies utilize different cutoffs.
Serum 25-hydroxy vitamin D levels may affect the need for oxygen support therapyin patients with COVID-19.This associationwas preserved after adjusting for demographic variables and comorbidities.
This was a retrospective, observational, cohort study of patients with COVID-19 diseasewithin the Mount Sinai Health System.
Adultpatients were included if they were positive for COVID-19 via polymerase chain reaction (PCR) testing during the study period and hada serum 25(OH)D level measured within thethree months prior to their positive COVID-19 test, or on admission to the hospital.
Patientswere compared based upon their serum 25(OH)D and categorized as: deficient (<50 nmol/L) or sufficient(³50 nmol/L).
Patient characteristics including demographics, comorbiditiesand clinical outcomes were obtained from the MountSinai Data Warehouse and confirmed by manual chartreview.
The primary endpoints were hospital admission, needfor oxygen support, and mortality. The mortality endpoint wasdefined as 90-day mortality documented from the first positive COVID-19 test. Oxygen support was defined as the need ofinvasive mechanical ventilation, noninvasive ventilation (i.e.non-rebreather mask, venturi, high flow nasal cannula) or nasalcannula therapy.
Gavioli, E. M., Miyashita, H., Hassaneen, O. and Siau, E. (2021) ‘An Evaluation of Serum 25-Hydroxy Vitamin D Levels in Patients with COVID-19 in New York City’, J Am Coll Nutr, pp. 1-6.
Take Home Message Vitamin D deficiency/insufficiency was present in majority of hospitalized patients with COVID-19 or influenza A and correlated with severity and persisted in critical illness survivors at concentrations expected
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