No abstract

Objective: To explore the possible associations of serum 25-hydroxyvitamin D [25(OH)D] concentration with coronavirus disease 2019 in-hospital mortality and need for invasive mechanical ventilation. Patients and Methods: A retrospective, observational, cohort study was conducted at 2 tertiary academic medical centers in Boston and New York. Eligible participants were hospitalized adult patients with laboratory-confirmed COVID-19 between February 1, 2020, and May 15, 2020. Demographic and clinical characteristics, comorbidities, medications, and disease-related outcomes were extracted from electronic medical records. Results: The final analysis included 144 patients with confirmed COVID-19 (median age, 66 years; 64 [44.4%] male). Overall mortality was 18%, whereas patients with 25(OH)D levels of 30 ng/mL (to convert to nmol/L, multiply by 2.496) and higher had lower rates of mortality compared with those with 25(OH)D levels below 30 ng/mL (9.2% vs 25.3%; P¼.02). In the adjusted multivariable analyses, 25(OH)D as a continuous variable was independently significantly associated with lower in-hospital mortality (odds ratio, 0.94; 95% CI, 0.90 to 0.98; P¼.007) and need for invasive mechanical ventilation (odds ratio, 0.96; 95% CI, 0.93 to 0.99; P¼.01). Similar data were obtained when 25(OH)D was studied as a continuous variable after logarithm transformation and as a dichotomous (<30 ng/mL vs !30 ng/mL) or ordinal variable (quintiles) in the multivariable analyses. Conclusion: Among patients admitted with laboratory-confirmed COVID-19, 25(OH)D levels were inversely associated with in-hospital mortality and the 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.

The novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved into a worldwide crisis and was declared a global pandemic by the World Health Organization (WHO) on March 11, 2020 [1]. The rate of spread, range of clinical manifestations, morbidity, and mortality associated with COVID-19 has prompted special interest in understanding the factors that predispose individuals to infection and severe forms of the disease. Many of the early studies from China overlapped in finding that, in addition to older age, certain chronic medical conditions including hypertension, type 2 diabetes, and cardiovascular disease, are a risk factor for severe illness with . Of note, according to a recent study, diverse haplotypes of SARS-CoV-2 were identified in distinct areas, probably due to different sources of exposure [6]. However, no evidence exists whether these haplotypes are responsible for differences in clinical manifestations of the disease.The pandemic has spread worldwide, affecting N200 countries and territories. As of April 13, 2020, the number of global cases has surpassed 1.7 million, including over 110,000 deaths; the United States alone has reported over 500,000 cases and 20,444 deaths [7]. According to a recent study in Iceland, the percentage of people at high risk for infection (mainly patients with symptoms, those who had close contact with infected persons, and those who had recently traveled to areas where there is major community spread) who tested positive for SARS-CoV-2 infection was approximately 13%. In comparison, the percentage of infected individuals in the general population was 0.8%, which remained stable over the course of 20 days. It should be noted that children under ten years of age and females had a lower incidence of SARS-CoV-2 infection compared to adolescents or adults and males [6]. These initial data on incidence and prevalence are likely to change significantly over time with the progression of the pandemic and with the expected availability of better tests to confirm diagnosis as well as short and long-term immunity.Emerging literature from Italy and the United States has also pointed to a higher burden of severe disease in individuals with chronic medical conditions. Preliminary data in the United States identified diabetes as the most common risk factor for SARS-CoV-2 infection [8]. In this editorial, we review the clinical observations related to diabetes and COVID-19 in China, Italy, and the United States. We next review the pathogenesis of and immune response to SARS-CoV-2 infection. We then outline proposed mechanisms that may predispose individuals with diabetes both to infection and severe disease. Finally, we highlight areas that warrant further investigation and discuss management considerations for clinicians.