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Lack of association of baseline 25-hydroxyvitamin D levels with disease severity and mortality in Indian patients hospitalized for COVID-19

Take Home Message

In this cross-sectional, observational study of 410 patients hospitalized between July 9 and August 8, 2020 for COVID-19 in New Delhi, India, serum 25-(OH)D levels at admission did not correlate with inflammatory markers, clinical outcomes, or mortality. In addition, treatment of vitamin D deficient patients [25-(OH)D < 20 ng/mL (< 50 nmol/l)] with cholecalciferol (60,000 units) did not alter outcomes.

Results

  • During the hospital stay, 57 (13.9%) patients had severe outcomes, including mortality in 15 (3.7%),
  • Of the 410 patients recruited, patients defined as VDD (197 patients, 48.2%) were significantly younger and had fewer comorbidities.
  • The proportion of severe cases (13.2% vs.14.6%), mortality (2% vs. 5.2%), oxygen requirement (34.5% vs.43.4%), and ICU admission (14.7% vs.19.8%) was not significantly different between patients with or without VDD, respectively.
  • There was no significant correlation between serum 25-(OH)D levels and inflammatory markers.
  • Among VDD patients, 128 (64.9%) were treated with oral cholecalciferol (median dose of 60,000 IU). The proportion of severe cases, oxygen, or ICU admission was not significantly different in the vitamin D treated vs untreated groups.

Who

A total of 410 (283 men, 69%; 127 women, 31%) consecutive patients hospitalized in New Delhi, India with COVID-19 infection confirmed by positive nasal and/or nasopharyngeal swab for SARS-CoV-2 by RT-PCR method were included in this study. The median age was 54 years, ranging from 6-92 years (including 9 patients < 18 years of age).

Things to Keep in Mind

  • The observational design of the study cannot substantiate causality between serum vitamin D levels and severity of COVID-19 disease.
  • A significant limitation is the lack of information on vitamin D supplementation prior to admission.
  • Obesity is an important contributor to COVID severity, however, data on BMI was available only for 136 patients.
  • During hospital stay, cholecalciferol treatment was administered per the decision of the treating physician, and not planned as part of the study, and physician bias in treatment decision and dosing cannot be ruled out.
  • The hospital predominantly caters to the middle and upper socioeconomic class from the National Capital Region of India. Therefore, the authors were unable to assess socioeconomic or ethnic factors that could affect infectivity and results may not be applicable to the entire Indian population.

Author’s Conclusions

Serum 25-(OH)D levels at admission did not correlate with inflammatory markers, clinical outcomes, or mortality in hospitalized COVID-19 patients with a high prevalence of VDD. Treatment of VDD with 60,000 units of cholecalciferol did not seem to offer any benefits with respect to immediate outcomes.

Study Design

  • This prospective, single-center, cross-sectional, observational study was carried out at a tertiary care center in New Delhi, India. Hospitalized patients were enrolled from July 9, 2020 to August 8, 2020, and were observed until the time of discharge or death while in the hospital.
  • COVID-19 infection was confirmed by positive nasal and/or nasopharyngeal swab for SARS-CoV-2 virus by RT-PCR.
  • Clinical data were collected from the electronic medical records including age, sex,presence of comorbidities, presenting symptoms, duration of symptoms, anthropometry, blood pressure, baseline oxygen saturation (SpO2), results of laboratory evaluation, and treatment received.
  • All patients were assigned a severity score based on the WHO ordinal scale for clinical improvement (OSCI) at hospital admission (baseline) and the highest score during the hospital stay (outcome). Based on the outcome OSCI scores, patients were classified as hospitalized mild disease (3-no oxygen therapy, 4-oxygen by mask or nasal prongs) or hospitalized severe disease (5-non-invasive ventilation or high flow oxygen, 6-intubation and mechanical ventilation, 7-ventilation plus other organ support like inotropes/renal replacement therapy (RRT)/ extracorporeal membrane oxygenation (ECMO), 8-death).
  • All patients underwent blood sampling to determine serum 25-hydroxyvitamin-D (25-(OH)D) and parathormone (PTH) in addition to assessment of inflammatory markers, C-reactive protein (CRP), Interleukin-6 (IL-6), D-dimer, ferritin, lactate dehydrogenase (LDH) and procalcitonin.
  • Vitamin D deficiency (VDD) was defined by a level of 25-(OH)D < 20 ng/mL (< 50 nmol/l).
  • Any decision of supplementation was as per the treating physician’s discretion. For most patients, the treatment was administered as cholecalciferol granules (60,000 units per gram in a single dose).
  • The primary outcome was the proportion of severe COVID-19 cases in vitamin D deficient vs vitamin D sufficient patients. Other outcomes included the proportion of cases requiring admission to an intensive care unit (ICU), administration of oxygen, inotropic support and renal replacement therapy (RRT). Differences in the mean levels of inflammatory markers were compared as were the number of deaths in each group. Outcomes of patients who received cholecalciferol versus those who did not receive cholecalciferol treatment were compared in all patients and in the subgroup of VDD patients.

Reference

Jevalikar G, Mithal A, Singh A, Sharma R, Farooqui KJ, Mahendru S, Dewan A, Budhiraja S. Lack of association of baseline 25-hydroxyvitamin D levels with disease severity and mortality in Indian patients hospitalized for COVID-19. Sci Rep. 2021 Mar 18;11(1):6258. doi: 10.1038/s41598-021-85809-y. PMID: 33737631; PMCID: PMC7973709.

 

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Research Summaries

Changes in 25‐hydroxyvitamin D levels post‐vitamin D supplementation in people of Black and Asian ethnicities and its implications during COVID‐19 pandemic: A systematic review

Changes in 25‐hydroxyvitamin D levels post‐vitamin D supplementation in people of Black and Asian ethnicities and its implications during COVID‐19

Vitamin D insufficiency in COVID-19 and influenza A, and critical illness survivors: a cross-sectional study

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

2022-05-11T11:38:40-05:00