Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness

Abstract

Objective: Studies have demonstrated a potential link between low vitamin D levels and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes but have not established temporality. This retrospective study examined if, and to what degree, a relationship exists between pre-infection serum vitamin D levels and disease severity and mortality of SARS-CoV-19. Design and patients: The records of individuals admitted between April 7th, 2020 and February 4th, 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 were searched for vitamin D (VitD) levels measured 14 to 730 days prior to the positive PCR test. Measurements: Patients admitted to GMC with COVID-19 were categorized according to disease severity and VitD level. Association between pre-infection VitD levels and COVID-19 severity was ascertained utilizing a multivariate regression analysis. Results: Of 1176 patients admitted, 253 had VitD levels prior to COVID-19 infection. Compared with mildly or moderately diseased patients, those with severe or critical COVID-19 disease were more likely to have pre-infection vitamin D deficiency of less than 20 ng/mL (OR=14.30, 95%, 4.01-50.9; p < .001); be older (OR=1.039 for each year, 95% CI for OR, 1.017-1.061; p< .01), and have diabetes (OR=2.031, 95% CI for OR, 1.04-3.36; p= 0.038). Vitamin D deficiency was associated with higher rates of mortality (p<0.001) and comorbidities including COPD (p=0.006), diabetes (p=0.026), and hypertension (p =0.016). Conclusions: Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.

Type 2 Diabetes Contributes to Altered Adaptive Immune Responses and Vascular Inflammation in Patients With SARS-CoV-2 Infection

“…The proposed mechanism involves a direct stimulation of insulin-producing pancreatic cells via their vitamin D receptors and an indirect stimulation via normalization of systemic calcium levels, allowing appropriate calcium-induced insulin secretion ( 83 ). Despite there being no clinical trials demonstrating that low Vitamin D levels lead to higher SARS-CoV-2 susceptibility, there have been numerous studies showing that the pre-infection Vitamin D deficiency is associated with increased morbidity and mortality and hence lower Vitamin D levels are likely a good predictor for disease progression ( 84 ).…”

Promising Therapeutic Approach for SARS‐CoV‐2 Infections by Using a Rutin‐Based Combination Therapy

“…There is evidence in the literature that insufficient serum vitamin D levels are associated with an increased risk of acute respiratory infections, including the COVID‐19 disease [15a–d] . Several studies suggested that taking vitamin D 3 (see Figure 1) [15e] may have a positive effect on the course of SARS‐CoV‐2 infections and provided strong evidence of a causal relationship between low vitamin D status and an increased risk of severe COVID‐19 disease [15a–c] . Due to a lot of encouraging data, the use of vitamin D to reduce the severity of SARS‐CoV‐2 infections is receiving considerable attention.…”

Obesity, Hypovitaminosis D, and COVID-19: the Bermuda Triangle in Public Health

“…Additionally, hypovitaminosis D was found to be an independent risk factor for SARS-CoV-2 infection and hospitalization due to COVID-19 after adjustment for demographic variables (age, gender, and BMI) and comorbidities [ 70 ]. A recent study has shown that pre-infection vitamin D deficiency was associated with increased COVID-19 severity, independently of age, gender, BMI, and comorbidities and also with higher mortality due to COVID-19 [ 71 ]. Of note, the researchers used a cosinor model to account for any influence of the seasonal variation of vitamin D status.…”

“…Hypovitaminosis D is an independent risk factor for SARS-CoV-2 infection and hospitalization [ 70 , 71 ]…”