Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients

Abstract

The coronavirus disease 2019 (COVID-19) pandemic poses a worldwide healthcare challenge that needs an efficient response. Unfortunately, to date there is no highly effective treatment, so a deep understanding of COVID-19 risk factors could be an important step in treating the disease. Vitamin D affects the immune system in many different ways, and other authors already found that COVID-19 patients have low levels of vitamin D. In our retrospective study, we evaluated the vitamin D status at the time of hospital admission in 50 COVID-19 patients in Sicily, which is the southernmost region of Italy, and compared them with 100 control subjects matched for age and sex. Our data showed markedly low levels of vitamin D in patients with a positive polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but no association was found with inflammation markers or clinical severity. Vitamin D levels were reduced at the time of hospital admission in Sicilian SARS-CoV-2-positive patients, but it is not clear whether this condition has an impact on the clinical course of COVID-19.

Vitamin D, infections and immunity

“…Although 25D status was not correlated with changes in clinical course, low levels of 1,25D were linked with prolonged mechanical ventilation and a worse acute physiology and chronic health evaluation score in 26 patients receiving intensive care with confirmed SARS-CoV-2 infection and COVID-19 induced acute respiratory distress syndrome [ 129 ]. In a retrospective study conducted in Sicily, low levels of vitamin D were observed in 50 hospital patients with a positive polymerase chain reaction (PCR) for SARS-CoV-2 [ 130 ]. Despite this finding, an association could not be found between low vitamin D status and increased markers of inflammation or clinical severity [ 130 ].…”

“…In a retrospective study conducted in Sicily, low levels of vitamin D were observed in 50 hospital patients with a positive polymerase chain reaction (PCR) for SARS-CoV-2 [ 130 ]. Despite this finding, an association could not be found between low vitamin D status and increased markers of inflammation or clinical severity [ 130 ]. In addition, a meta-analysis of 31 observational studies found a trend between serum 25D levels of less than 20 ng/ml (50 nM) and an increased risk of mortality, ICU admission and ventilation; however, these associations were not found to be statistically significant [ 131 ].…”

Vitamin D, SARS-CoV-2 and Causal Associations in Transversal Studies: The Time-Series Analysis to Reveal Potential Confounders. Comment on Gaudio et al. Vitamin D Levels Are Reduced at the Time of Hospital Admission in Sicilian SARS-CoV-2-Positive Patients. Int. J. Environ. Res. Public Health 2021, 18, 3491

“…A consequence of the hypothesis of the selection bias is that the levels of vitamin D in the patients (12.5 ng/mL) and controls (20.5 ng/mL) in the Gaudio study are, respectively, similar to those of our baseline (9.6 ng/mL) and post-changepoint cases (19.3 ng/mL) [ 1 ]. In particular, for the post-changepoint cases, which displayed unexpected results, their behavior suggests that the observed effect is only that of the factors that regulate vitamin D status in the general population (such as oral supplementation, age, comorbidities, diet, etc.…”

“…We read with great interest the paper by Gaudio and colleagues on vitamin D and on the state of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of admission [ 1 ]. The study involved a small cohort enrolled from March to July 2020, which was the time of the first wave of the pandemic.…”

Vitamin D in infectious complications in critically ill patients with or without COVID-19

“…Thus, it has been proposed that diagnosis of vitamin D deficiency could aid in identifying patients prone to developing severe COVID-19, defined as presence of ARDS and/or need for mechanical ventilation, ICU vs ward admission, and lower survival probability. Vitamin D levels were lower in hospitalized COVID-19 patients compared to healthy controls, however, no relationship could be established between vitamin D concentrations and the severity of the disease or its clinical course [ 75 , 76 ]. No significant association between vitamin D levels and severity, mortality, mechanical ventilation, ICU admission, and the development of thromboembolism was observed in COVID-19 patients [ 77 , 78 ].…”