Background
There is controversy regarding the association between hypovitaminosis D and COVID-19 outcomes.
Aim of the study
We assessed the association between 25-hydroxyvitamin D levels and COVID-19 outcomes in hospitalized subjects with severe SARS-CoV-2 infection.
Methods
Retrospective cohort study. Serum 25-hydroxyvitamin D levels of subjects with severe COVID-19 pneumonia were measured at hospital admission, between March 17th, 2020, and March 1st, 2021.
Results
Out of 2,908 patients, 571 (19.6%) had vitamin D deficiency (defined as a serum 25-hydroxyvitamin D level <12.5 ng/mL [<31.25 nmol/L]), and 1069 (36.7%) had levels between 12.5 ng/mL (31.25 nmol/L) and 20 ng/mL 850 nmol/L). Compared to subjects without vitamin D deficiency, those with 25-hydroxyvitamin D level <12.5 ng/mL had higher rates of in-hospital mortality at 30 d (28.0 vs. 17.3%; p <0.001), global mortality (31.9 vs. 20.8%; p <0.001), mechanical ventilation requirement (23.8 vs. 17.2%; p <0.001), and significantly longer hospital stay (median [interquartile range] of 9 [6–17 d] vs. 7 [5–12 d], p <0.001). In the unadjusted analysis, the risk of in-hospital death was greater for patients with vitamin D deficiency (HR 1.43; 95% CI, 1.20–1.70; p <0.001). After adjusting for confounders, the risk of in-hospital death within 30 d remained significantly greater in patients with vitamin D deficiency (HR 1.46; 95% CI, 1.21–1.76; p <0.001). The risk was reduced but remained significant with 25-hydroxyvitamin D levels between 12.5 ng/mL and 20 ng/mL (HR 1.31; 95% CI 1.10–1.55, p = 0.02). In comparison with other clinical biomarkers, vitamin D deficiency was an independent predictive marker of in-hospital mortality after adjusting for confounders.
Conclusion
Very low 25-hydroxyvitamin D levels measured at hospital admission were significantly associated with in-hospital mortality and are a useful prognostic biomarker in severe COVID-19 patients.
【저자키워드】 COVID-19, SARS-CoV-2, Mortality, Vitamin D, 25-hydroxyvitamin D, Length of hospital stay, 【초록키워드】 Severe COVID-19 pneumonia, Biomarkers, Hospitalized, mechanical ventilation, Infection, risk, outcome, cohort study, outcomes, Patient, Hospital admission, patients, in-hospital mortality, prognostic biomarker, association, marker, Analysis, Hypovitaminosis D, Hospital stay, Predictive, In-hospital death, deficiency, 95% CI, subject, severe COVID-19 patients, confounders, serum 25-hydroxyvitamin D, independent, severe SARS-CoV-2, Result, greater, defined, significantly, remained, median, were measured, was reduced, global mortality, 【제목키워드】 Level, Strong,