Serum 25(OH)D Level on Hospital Admission Associated With COVID-19 Stage and Mortality.

This retrospective, observational study suggests that there may be an association between vitamin D deficiency on hospital admission and mortality of COVID-19 pneumonia, independent of other conditions that might be impacted by vitamin D, such as chronic lung disease, coronary artery disease, and diabetes.

• Most patients presented in late stage 3 pneumonia (46%, 85/186), with 25% and 30% in stages 1 and 2, respectively, with similar distribution in men and women.
• A high fraction (59%, 109/186) of patients with COVID-19 were vitamin D deficient (25(OH)D <20 ng/mL) on admission: 47% of women and 67% of men.
• Male patients, not female, with COVID-19 showed progressively lower median 25(OH)D with advancing stage of pneumonia, resulting in vitamin D deficiency rates of 55% in stage 1, 67% in stage 2, to 74% in stage 3.
• Vitamin D deficiency on admission was not influenced by age, ethnicity, chronic lung disease, coronary artery disease/hypertension, or diabetes and was associated with mortality independent of age, chronic lung disease, and extent of lung damage expressed by chest CT severity score.
• 15% of COVID-19 positive patients (27/186) died, 67% were men. Patients who died were older (median age, 81 vs 67 years), had higher prevalence of chronic lung disease (33% vs 12%) and coronary artery disease (82% vs 55%), and showed higher CT severity scores (15 vs 11) and lower median 25(OH)D level (15.2 vs 18.9 ng/mL) than survivors.

186 subjects who tested positive for COVID-19 and were hospitalized from March 1, 2020, to April 7, 2020, for COVID-19 pneumonia at AZ Delta General Hospital, a tertiary network hospital in Roeselare, Belgium. The study population included 109 men (median age, 68 years; 53-79 years) and 77 women (median age, 71 years; 65-74 years).

• This was a single center small study. They did attempt to account for some of the major health issues that might also impact vitamin D and outcomes, but not every factor was considered.
• No intervention took place, this study was strictly observational.

The study shows an association between vitamin D deficiency on admission and mortality of COVID-19 pneumonia, independent of vitamin D–impacted comorbidities such as chronic lung disease, coronary artery disease, and diabetes. It highlights the need for RCTs targeting specifically vitamin D–deficient patients at intake and makes a call for general avoidance of vitamin D deficiency as a safe and inexpensive possible mitigation of the SARS-CoV-2 pandemic.

• This was a retrospective observational study. No intervention took place.
• On admission, serum 25(OH)D level was measured and the radiologic stage of COVID-19 pneumonia was determined by chest CT Image.
• These stages correspond to the phase of COVID-19, with an early phase of active viral replication in lower airways (stage 1) and progressive recruitment of proinflammatory cells to the lung interstitial space (stage 2), ending in alveolar damage and fibrosis (stage 3).
• Percentage of pulmonary tissue affected by COVID-19 pneumonia was determined by CT severity score on a scale from 0 to 25, calculated by scoring loss of well-aerated functional lung tissue for each individual pulmonary lobe on a scale from 0 to 5 and summating this score for the five lobes.
• Medical charts were reviewed for medical history and conditions that may also impact results. These included the prevalence of diabetes, chronic lung disease (emphysema, fibrosis, bronchiectasis) and coronary artery disease.

De Smet D, De Smet K, Herroelen P, Gryspeerdt S, Martens GA. Serum 25(OH)D Level on Hospital Admission Associated With COVID-19 Stage and Mortality. Am J Clin Pathol. 2021 Feb 11;155(3):381-388. doi: 10.1093/ajcp/aqaa252. PMID: 33236114; PMCID: PMC7717135