Vitamin D levels and in-hospital mortality of COVID-19

Year 2022, Volume: 5 Issue: 2, 457 - 461, 15.03.2022

Emre Sedar Saygılı Ersen Karakılıç

https://doi.org/10.32322/jhsm.1056650

Cited By: 2

Abstract

Introduction: Vitamin D deficiency may be linked to an increased susceptibility risk of COVID-19. However, the data on the link between vitamin D levels and COVID-19 related in-hospital mortality is debatable. This study investigated whether vitamin D levels are associated with intensive care unit (ICU) admission and COVID-19 related in-hospital mortality.
Material and Method: We conducted a retrospective study with hospitalized COVID-19 patients between March 2020 and March 2021. 25 OH Vitamin D (Vit-D) levels <12 ng/mL were accepted as Vit-D deficiency. The patients were evaluated in two groups as Vit-D deficient and Non-Vit-D deficient. Groups were matched 1:1 by propensity score matching (PSM) regarding age and gender.
Results: A total of 192 patients, 52.6% (101) of whom were female, with a median age of 71 (IQR:61-78), were included in the study. Before PSM analysis, the Vit-D deficient group patients were older, female predominant, have more mortality rates. After PSM, 122 cases (61 cases for each group) remained, and mortality between Vit-D groups was statistically similar (34% vs. 26%, p=0.32). In the univariate logistics regression analysis before PSM, Vit-D level was a significant for mortality (OR:0.972 CI:0.945-0.999, p=0.044); after PSM statistical significance was lost (OR:0.96 CI:0.934-1.005, p=0.087). ICU admission rates were similar between groups.
Conclusion: Although mortality was higher in the group with Vit-D deficiency in the first analysis, it lost its significance on mortality after adjusting groups for age and gender. There was no relationship between vitamin D deficiency and COVID-19 in-hospital mortality.

Keywords

Vitamin D, COVID-19, Mortality, Critical Care, Hospitalization

Supporting Institution

The authors declared that this study had received no financial support.

Thanks

We acknowledge and thank all of the doctors, nurses and other medical personnel at our hospital who provided care to patients during the COVID-19 pandemic. Especially, we would like to thank Dr.Erdal Mert for his support.

References

• Bouillon R, Marcocci C, Carmeliet G, et al. Skeletal and extra-skeletal actions of vitamin D: current evidence and outstanding questions. Endocr Rev 2019; 40: 1109-51.
• Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-81.
• Charoenngam N, Holick MF. Immunologic effects of vitamin D on human health and disease. Nutrients 2020; 12: 2097.
• Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients 2015; 7: 4240-70.
• Mercola J, Grant WB, Wagner CL. Evidence regarding vitamin D and risk of COVID-19 and its severity. Nutrients 2020; 12: 3361.
• Grant WB, Giovannucci E. The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918–1919 influenza pandemic in the United States. Dermatoendocrinol 2009; 1: 215-9.
• Dissanayake HA, de Silva NL, Sumanatilleke M, et al. Prognostic and therapeutic role of vitamin D in COVID-19: systematic review and meta-analysis. J Clin Endocrinol Metab 2021; dgab892.
• Ghasemian R, Shamshirian A, Heydari K, et al. The role of vitamin D in the age of COVID‐19: A systematic review and meta‐analysis. Int J Clin Pract 2021; 75: e14675.
• Chiodini I, Gatti D, Soranna D, et al. Vitamin D status and SARS-CoV-2 infection and COVID-19 clinical outcomes. Front Public Health 2021; 9: 736665.
• Giustina A, Adler RA, Binkley N, et al. Controversies in vitamin D: summary statement from an international conference. J Clin Endocrinol Metab 2019; 104: 234-40.
• Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011; 10: 150-61.
• Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-12.
• Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012; 120: c179-84.
• Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. multivar behav Res 2011; 46: 399-424.
• Contreras-Bolívar V, García-Fontana B, García-Fontana C, Muñoz-Torres M. Vitamin D and COVID-19: where are we now? Postgrad Med 2021; 1-13
• Liu N, Sun J, Wang X, Zhang T, Zhao M, Li H. Low vitamin D status is associated with coronavirus disease 2019 outcomes: a systematic review and meta-analysis. Int J Infect Dis 2021; 104: 58-64.
• Düğeroğlu H. Evaluation of 25-hydroxy vitamin D levels in COVID-19 positive patients. J Health Sci Med 2021; 4: 931-5.
• Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 2020; 395: 497-506.
• Yıldırım Ö, Bayram M, Özmen RS, et al. Evaluation of hematological indices in terms of COVID-19 related mortality and ICU admission. J Health Sci Med 2021; 4: 666-9.
• Tavakolpour S, Rakhshandehroo T, Wei EX, Rashidian M. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunol Lett 2020; 225: 31-2.
• Pecina JL, Merry SP, Park JG, Thacher TD. Vitamin D status and severe COVID-19 disease outcomes in hospitalized patients. J Prim Care Community Health 2021; 12: 1-7
• Reis BZ, Fernandes AL, Sales LP, et al. Influence of vitamin D status on hospital length of stay and prognosis in hospitalized patients with moderate to severe COVID-19: a multicenter prospective cohort study. Am J Clin Nutr 2021; 114: 598-604.
• Weaving G, Batstone GF, Jones RG. Age and sex variation in serum albumin concentration: an observational study. Ann Clin Biochem 2016; 53: 106-11.
• Oscanoa TJ, Amado J, Ghashut RA, Romero-Ortuno R. Relationship between serum 25-hydroxyvitamin D concentration and acute inflammatory markers in hospitalized patients with SARS-CoV-2 infection. Disaster Emerg Med J 2021; 6: 144-53.
• Hernández JL, Nan D, Fernandez-Ayala M, et al. Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection. J Clin Endocrinol Metab 2021; 106: e1343-53.
• Bitencourt L, Pedrosa AL, de Brito SBCS, et al. COVID-19 and Renal Diseases: An Update. Curr Drug Targets 2021; 22: 52-67.
• Xiang HX, Fei J, Xiang Y, et al. Renal dysfunction and prognosis of COVID-19 patients: a hospital-based retrospective cohort study. BMC Infect Dis 2021; 21: 158.
• Franca Gois PH, Wolley M, Ranganathan D, Seguro AC. Vitamin D Deficiency in Chronic Kidney Disease: Recent Evidence and Controversies. Int J Environ Res Public Health 2018; 15: 1773.
• Torres B, Alcubilla P, González-Cordón A, et al. Impact of low serum calcium at hospital admission on SARS-CoV-2 infection outcome. Int J Infect Dis 2021; 104: 164-8.
• Alemzadeh E, Alemzadeh E, Ziaee M, Abedi A, Salehiniya H. The effect of low serum calcium level on the severity and mortality of Covid patients: A systematic review and meta‐analysis. Immun Inflamm Dis 2021; 9: 1219-28.
• Aldasouqi S, Glassy CM, Glassy MS, Treska A, Caldwell-McMillan M, Gossain V. Asymptomatic severe hypocalcemia secondary to vitamin d deficiency in an elderly patient. Case Rep Endocrinol 2011; 2011: e830952.
• Ünsal YA, Gül ÖÖ, Cander S, et al. Retrospective analysis of vitamin D status on ınflammatory markers and course of the disease in patients with COVID-19 infection. J Endocrinol Invest 2021; 44: 2601-7.
• Hastie CE, Pell JP, Sattar N. Vitamin D and COVID-19 infection and mortality in UK Biobank. Eur J Nutr 2021; 60: 545-8.