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Vitamin D Status Is Associated With In-Hospital Mortality and Mechanical Ventilation: A Cohort of COVID-19 Hospitalized Patients 

Take Home Message

Among patients admitted with laboratory-confirmed  COVID-19, low serum vitamin D [25(OH)D] levels were associated with greater in-hospital mortality and need for invasive mechanical ventilation. Further observational studies are needed to confirm these findings, and randomized clinical trials must be conducted to assess the role of vitamin D administration in improving the morbidity and mortality of COVID-19.

Who

Eligible participants were 144 hospitalized adult patients with laboratory-confirmed (polymerase chain reaction; PCR) COVID-19 in Boston and New York City (Beth Israel Deaconess Medical Center in Boston, Massachusetts, and Montefiore Medical Center in the Bronx, New York) for whom necessary information was available. The study population consisted of 144 patients with PCR-confirmed COVID-19 (80 [55.6%] women; median age, 66 years; range, 55-74 years). Of the 144 patients, 60 (41.7%) were non-Hispanic Black, 42 (29.2%) non-Hispanic White and 33 (22.9%) Hispanic/Latino. 

Length of Study

Between February 1, 2020 and May 15, 2020  

Results

  • Overall, in-hospital mortality was 18%. Patients with 25(OH)D levels of 75 nmol/L and higher had lower rates of mortality compared with those with levels below 75 nmol/L (9.2% vs 25.3%; P=0.02). 
  • When the demographic and clinical characteristics of the patients and their pre-existing medical conditions were included in the data analysis, higher serum 25(OH)D levels were significantly associated with reduced in-hospital mortality  and need for invasive mechanical ventilation. 
  • Increasing age, chronic obstructive pulmonary disease and active malignant disease were also independently associated with inhospital mortality. An association with invasive mechanical ventilation was observed for end-stage renal disease, C-reactive protein level (a marker of inflammation) and corticosteroid use. Corticosteroids appeared to be administered in critically ill patients needing invasive mechanical ventilation. 

Things to Keep in Mind

  • The sample size was relatively small. 
  • Approximately half of the patients (73 [51%]) did not have 25(OH)D measurements available during their hospitalization (instead within 6 months before the initiation of the study), which raises the possibility that some of the participants might have received vitamin D supplementation before hospitalization that was not recorded in the electronic medical record.  
  • Seasonal variability may affect 25(OH)D concentration, and the results may be lower in winter months.  
  • The ability to draw causal inferences is limited by the retrospective design of the study.

Author’s Conclusions

In adults admitted to the hospital with laboratory-confirmed COVID-19, 25(OH)D levels were independently associated with in-hospital mortality and need for invasive mechanical ventilation. However, given the lack of consistent benefit of vitamin D supplementation in the critically ill in randomized trials, observational trials of vitamin D status and COVID-19 outcomes should be interpreted with caution. Given the safe profile and low cost, further investigation of vitamin D supplementation as a preventive and therapeutic strategy for COVID-19 with randomized trials is warranted. 

Study Design

  • This study was a retrospective, observational, cohort study conducted at 2 tertiary academic medical centers in Boston and New York. 
  • Demographic and clinical characteristics, comorbidities, medications and disease-related outcomes were extracted from electronic medical records.  
  • A serum 25(OH)D measurement was required. 25(OH)D concentrations were obtained during admission/hospitalization or as noted in the medical record in the 6 months prior to the initiation of the study. 
  • The primary outcome of the study was inhospital mortality. The secondary outcome was need for invasive mechanical ventilation. 

Reference

Angelidi AM, Belanger MJ, Lorinsky MK, Karamanis D, Chamorro-Pareja N, Ognibene J, Palaiodimos L, Mantzoros CS. Vitamin D Status Is Associated With In-Hospital Mortality and Mechanical Ventilation: A Cohort of COVID-19 Hospitalized Patients. Mayo Clin Proc. 2021 Apr;96(4):875-886. doi: 10.1016/j.mayocp.2021.01.001. Epub 2021 Jan 9. PMID: 33714594; PMCID: PMC7834253 https://pubmed.ncbi.nlm.nih.gov/33714594/

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2021-06-15T07:43:07-05:00