Low Serum 25-hydroxyvitamin D (25OHD) Levels in Patients Hospitalised With COVID-19 Are Associated With Greater Disease Severity
Clin Endocrinol (Oxf). 2020 Jul 3. doi: 10.1111/cen.14276.
Grigorios Panagiotou 1, Su Ann Tee 1, Yasir Ihsan 1, Waseem Athar 2, Gabriella Marchitelli 3, Donna Kelly 4, Christopher S Boot 5, Nadia Stock 3, James Macfarlane 2, Adrian R Martineau 6, Graham Burns 2, Richard Quinton 1 7
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Objectives: Vitamin D deficiency (VDD) has been proposed to play a role in Coronavirus Disease 2019 (COVID-19) pathophysiology. We aim to evaluate our implementation of a local protocol for treatment of VDD among patients hospitalized for COVID-19; to assess the prevalence of VDD among COVID-19 inpatients, and examine potential associations with disease severity and fatality.
Design and participants: We conducted a retrospective interim audit of a local clinical care pathway for 134 inpatients with COVID-19. Prevalence of VDD, compliance with local treatment protocol and relationship of baseline serum 25(OH)D with markers of COVID-19 severity and fatality were analysed.
Results: 55.8% of eligible patients received Colecalciferol replacement, albeit not all according to the suggested protocol. Patients admitted to ITU were younger than those managed on medical wards (61.1 years ± 11.8 vs. 76.4 years ± 14.9, respectively, p<0.001), with greater prevalence of hypertension, higher baseline respiratory rate, National Early Warning Score-2 and C-Reactive protein level. While mean serum 25(OH)D levels were comparable (p=0.3), only 19% of ITU patients had 25(OH)D levels greater than 50 nmol/L vs. 39.1% of non-ITU patients (p=0.02). However, there was no association with fatality, potentially due to small sample size and prompt diagnosis and treatment of VDD.
Conclusions: Higher prevalence of VDD was observed in patients requiring ITU admission compared to patients managed on medical wards. Larger prospective studies and/or clinical trials are needed to validate and extend our observations.