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Vitamin D status and outcomes for hospitalised older patients with COVID-19.

Take Home Message

Older patients with COVID-19 infection and vitamin D deficiency (≤30 nmol/L) have higher peak D-dimer levels, an indication of blood clotting, and higher incidence of non-invasive ventilation (NIV) support and high dependency unity admission (HDU). Vitamin D deficiency may be associated with worse outcomes from COVID-19, and vitamin D status may be a useful predictor of outcomes.

Results

  • The group who were COVID-19-positive demonstrated significantly lower median serum 25(OH)D level of 27 nmol/L and markers of inflammation were higher compared with COVID-19-negative group, with median level of 52 nmol/L.
  • Among patients with vitamin D deficiency, there was significantly higher peak D-dimer level, a marker of blood clotting and increased inflammation which is associated with increased risk for multiple organ failure and death.
  • Vitamin D deficient patients demonstrated significantly higher incidence of NIV support and high dependency unit admission. No increased mortality was observed between groups.

Who

All emergency admissions >65 years of age admitted to a hospital in South England with COVID-19 related symptoms (N=105). 70 were diagnosed with COVID-19, and 35 were negative.

Things to Keep in Mind

This was a study done at a single center with a small group of patients. Information was obtained via second-hand review of medical charts and may leave out important aspects of the patients’ health. In addition, all of the patients were reporting with symptoms of some sort meaning there is no comparison to healthy controls. Looking only at vitamin D status must be considered since the entire health and nutritional status of the patient can influence outcomes.

Author’s Conclusions

Older adults with vitamin D deficiency and COVID-19 may demonstrate worse morbidity outcomes. Vitamin D status may be a useful prognosticator.

Study Design

  • The group was followed from March 1 to April 30, 2020.
  • The COVID-19 patients were divided based on vitamin D status into two groups vitamin D-deficient (≤30 nmol/L) (n=39) and replete group (>30 nmol/L) (n=35).
  • Subgroups were assessed for disease severity using biochemical, radiological and clinical markers.
  • Information was taken from medical notes and the local hospital electronic database. Information included age, weight, height, ethnicity, smoking status and comorbidities. Ethnicities were self-assigned.
  • Rockwood Clinical Frailty Score and Charlson Comorbidity Index were calculated.
  • Primary outcome was in-hospital mortality.
  • Secondary outcomes were laboratory features of cytokine storm (markers of inflammation), chest imaging changes and requirement of non-invasive ventilation (NIV).

 

Reference

Baktash V, Hosack T, Patel N, Shah S, Kandiah P, Van den Abbeele K, Mandal AKJ, Missouris CG. Vitamin D status and outcomes for hospitalised older patients with COVID-19. Postgrad Med J. 2020 Aug 27:postgradmedj-2020-138712. doi: 10.1136/postgradmedj-2020-138712. Epub ahead of print. PMID: 32855214; PMCID: PMC7456620.

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2021-07-27T12:11:07-05:00