Detectable respiratory SARS-CoV-2 RNA is associated with low vitamin D levels and high social deprivation

In this group of 104 patients hospitalized in the UK between January 31, 2020 and May 7, 2020, combined low vitamin D levels and higher social deprivation were most associated with COVID-19 infection. In older age, this combination was even more significant.

• In the total cohort, a positive SARS-CoV-2 test was significantly associated with lower 25-OHD levels and greater deprivation using the IMD.
• A positive test was associated with greater deprivation on the IMD scale in the male subgroup and with lower 25-OHD levels in those aged >72 years.
• Low 25-OHD and greater deprivation were separately associated with positive COVID-19 outcome in the cohort. Patients stratified as having greater deprivation with vitamin D levels ≤ 34.4 nmol/L (£76 ng/ml) were most likely to have a positive COVID-19 outcome, even more so if aged >72 years (OR: 19.07, 95%CI: 1.71-212.25; P = .016).

One-hundred four patients in the UK were tested for SARS-CoV-2 RNA on hospital admission with symptoms suggestive of COVID-19. Of these, 57 were SARS-CoV-2 RNA negative (38 women, 66.7%; 19 men, 33.3%); 47 were SARS-CoV-2 RNA positive (27 women, 57.4%; 20 men, 42.6%). Mean age in the SARS-CoV-2 negative group was 68.5±18.1 years, ranging from 25-95 years. Mean age in the SARS-CoV-2 positive group was 68.6±18.7, ranging from 22-95 years.

• A larger, more robust study with the analyses adjusted for ethnicity, body mas index, and comorbidities is required to validate the findings with the cohort size allowing for subgroup analyses of different populations (e.g., different ethnic groups, patients on vitamin D supplements) at varying levels of risk, which could not be considered in this study as the data were not accessible.
• The vitamin D status evaluated in this study was measured within the 6 months prior to or at hospital admission. Studies with recent vitamin D measures for all patients, such as those taken at the time of hospital admission with symptoms of COVID-19 infection, would provide a more consistent dataset.

In this cohort, combined low vitamin D levels and higher social deprivation were most associated with COVID-19 infection. In older age, this combination was even more significant.

• Upper or lower respiratory tract samples from 104 consecutive patients who were admitted between January 31, 2020 toMay 7, 2020 to Walsall Manor Hospital, Walsall UK were tested for SARS-CoV-2 RNA in accordance with Public Health England criteria using reverse-transcriptase polymerase chain reaction (RT-PCR) assay.
• The most recent serum total 25-hydroxyvitamin D(25-OHD) levels, quantified by liquid chromatography-tandem mass spectrometry, were obtained for each patient from the Clinical Biochemistry laboratory database for a period covering 6 months up to and including admission date (between September 1, 2019, and April 30, 2020).
• Index of Multiple Deprivation (IMD) was generated for each patient using their postal code. The English Indices of Deprivation combine factors of housing, social and economic issues to give a single deprivation score for small geographical areas in England.
• Univariate and logistic regression analyses examined associations between age, gender, 25-OHD, IMD score and SARS-CoV-2 result in the total cohort and subgroups.

Livingston M, Plant A, Dunmore S, Hartland A, Jones S, Laing I, Ramachandran S. Detectable respiratory SARS-CoV-2 RNA is associated with low vitamin D levels and high social deprivation. Int J Clin Pract. 2021 Apr 2:e14166. doi: 10.1111/ijcp.14166. Epub ahead of print. PMID: 33797849.