Introduction Coronavirus disease (COVID-19) is a global pandemic. Vitamin D deficiency has been associated with susceptibility to infectious disease. In this study, the association between COVID-19 outcomes and vitamin D levels in patients attending a COVID-19 reference center in Mexico City are examined. Methods Consecutive patients with confirmed COVID-19 were evaluated. All patients underwent clinical evaluation and follow-up, laboratory measurements and a thoracic computerized tomography, including the measurement of epicardial fat thickness. Low vitamin D was defined as levels <20 ng/ml (<50nmol/L) and deficient Vitamin D as a level ≤12 ng/ml (<30 nmol/L). Results Of the 551 patients included, low vitamin D levels were present in 45.6% and deficient levels in 10.9%. Deficient Vitamin D levels were associated with mortality (HR 2.11, 95%CI 1.24–3.58, p = 0.006) but not with critical COVID-19, adjusted for age, sex, body-mass index and epicardial fat. Using model-based causal mediation analyses the increased risk of COVID-19 mortality conferred by low vitamin D levels was partly mediated by its effect on D-dimer and cardiac ultrasensitive troponins. Notably, increased risk of COVID-19 mortality conferred by low vitamin D levels was independent of BMI and epicardial fat. Conclusion Vitamin D deficiency (≤12 ng/ml or <30 nmol/L), is independently associated with COVID-19 mortality after adjustment for visceral fat (epicardial fat thickness). Low vitamin D may contribute to a pro-inflammatory and pro-thrombotic state, increasing the risk for adverse COVID-19 outcomes.
【저자키워드】 COVID-19, SARS-CoV-2, severe COVID-19, Vitamin D, Adipose tissue, 【초록키워드】 Mortality, susceptibility, Sex, risk, D-dimer, Infectious disease, outcome, vitamin D deficiency, global pandemic, outcomes, Computerized tomography, clinical evaluation, Patient, age, Follow-up, Mediation analysis, BMI, disease, Critical, association, COVID-19 mortality, Thoracic, Mexico City, 95%CI, increased risk, vitamin D level, pro-inflammatory, fat, independent, Result, defined, examined, evaluated, adjusted, contribute, body-mass, Deficient, laboratory measurement, pro-thrombotic, visceral, with COVID-19, 【제목키워드】 independent of, Level, Increased,