Real world evidence of calcifediol use and mortality rate of COVID-19 hospitalized in a large cohort of 16,401 Andalusian patients

Abstract

Background: COVID-19 is a major worldwide health problem because of acute respiratory distress syndrome, and mortality. Several lines of evidence have suggested a relationship between the vitamin D endocrine system and severity of COVID-19. Methods: We present a retrospective survival study that includes all Andalusian patients hospitalized between January and November 2020 because of COVID-19 infection. Based on a central registry of electronic health records (the Andalusian Population Health Database, BPS), prescription of vitamin D or its metabolites within 15-30 days before hospitalization were recorded. The effect of treatment with vitamin D metabolites for other indication previous to the hospitalization was studied with respect to patient survival by means of Kaplan-Meyer survival curves and Log Hazard Ratios, using a propensity score to compensate the disbalance of compared classes and the confounding factors. The availability of detailed patient data in the BPS allowed to obtain Real-World Evidence (RWE) of the effects of prior use of vitamin D or its metabolites on the mortality due to COVID-19 infection. Findings: A retrospective cohort of 16.401patients was extracted from the BPS, which includes all the patients hospitalized with COVID-19 diagnosis between January and November 2020 in Andalusia, one of the largest regions in Europe with the size of an average median country. A total of 358 patients were found with cholecalciferol, and 193 with calcifediol, prescriptions 15 days before hospitalization. For a period extended to 30 days before hospitalization, the numbers increase to 416 and 210 and, respectively. Kaplan-Meyer survival curves and hazard ratios support an association between consumption of these metabolites and patient survival. Such association was stronger in calcifediol (Log Hazard Ratio, LHR = -1.27±0.32) than in cholecalciferol (LHR= -0.56±0.15), when prescribed 15 days before hospitalization This effect decreases when a larger 30 days period is considered (calcifediol LHR= -1.01±0.27 and cholecalciferol LHR= -0.27±0.12), suggesting that the closer was the treatment to the hospitalization the stronger the association. Conclusions: A significant reduction in mortality in patients hospitalized with COVID-19 is associated with the prescription of vitamin D, especially calcifediol, within 15-30 days prior to hospitalization.

Vitamin D supplementation and COVID-19 risk: a population-based, cohort study

“…This has allowed to detect small differences in outcomes after adjusting for multiple covariates. Our study also differs from that of Loucera et al, a study that compares COVID-19 inhospital mortality in patients under vitamin D supplementation with unsupplemented, propensity score-matched, hospitalized COVID-19 patients, since it only analyzed hospitalized patients and not all the population at risk [38].…”

Vitamin D—A prominent immunomodulator to prevent COVID‐19 infection

“…However, numerous observational studies and open‐label, RCTs have demonstrated a substantial relationship between vitamin D and COVID‐19 ( Table 1 ). 52 , 59 , 62 , 67 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 …”

SARS-CoV-2 infection in multiple sclerosis patients: interaction with treatments, adjuvant therapies, and vaccines against COVID-19

“…They found that the need for admission to the ICU was much lower in the group treated with VD (2%) compared to standard treatment (50%) [ 164 ]. The retrospective study carried out by Loucera et al, 2021, which concluded that patients who had adjusted their serum levels of 25(OH)D, for other health objectives, within the 15–30 days prior to hospitalization, presented better response to COVID-19 and increased survival [ 165 ]. Another cross-sectional study in 508 patients, conducted by Vasheghani et al, 2021, reported that mortality from COVID-19 had a negative correlation with the serum level of 25(OH)D and in those patients who were hospitalized, low levels of 25(OH)D, were associated with more severe disease and increased ICU admissions [ 162 ].…”