Survival implications vs. complications: unraveling the impact of vitamin D adjunctive use in critically ill patients with COVID-19—A multicenter cohort study

DOI record: { "DOI": "10.3389/fmed.2023.1237903", "ISSN": [ "2296-858X" ], "URL": "http://dx.doi.org/10.3389/fmed.2023.1237903", "abstract": "<jats:sec><jats:title>Background</jats:title><jats:p>Despite insufficient evidence, vitamin D has been used as adjunctive therapy in critically ill patients with COVID-19. This study evaluates the effectiveness and safety of vitamin D as an adjunctive therapy in critically ill COVID-19 patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A multicenter retrospective cohort study that included all adult COVID-19 patients admitted to the intensive care units (ICUs) between March 2020 and July 2021. Patients were categorized into two groups based on their vitamin D use throughout their ICU stay (control vs. vitamin D). The primary endpoint was in-hospital mortality. Secondary outcomes were the length of stay (LOS), mechanical ventilation (MV) duration, and ICU-acquired complications. Propensity score (PS) matching (1:1) was used based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analyses were employed as appropriate.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 1,435 patients were included in the study. Vitamin D was initiated in 177 patients (12.3%), whereas 1,258 patients did not receive it. A total of 288 patients were matched (1:1) using PS. The in-hospital mortality showed no difference between patients who received vitamin D and the control group (HR 1.22, 95% CI 0.87–1.71; <jats:italic>p</jats:italic> = 0.26). However, MV duration and ICU LOS were longer in the vitamin D group (beta coefficient 0.24 (95% CI 0.00–0.47), <jats:italic>p</jats:italic> = 0.05 and beta coefficient 0.16 (95% CI −0.01 to 0.33), <jats:italic>p</jats:italic> = 0.07, respectively). As an exploratory outcome, patients who received vitamin D were more likely to develop major bleeding than those who did not [OR 3.48 (95% CI 1.10, 10.94), <jats:italic>p</jats:italic> = 0.03].</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The use of vitamin D as adjunctive therapy in COVID-19 critically ill patients was not associated with survival benefits but was linked with longer MV duration, ICU LOS, and higher odds of major bleeding.</jats:p></jats:sec>", "alternative-id": [ "10.3389/fmed.2023.1237903" ], "author": [ { "affiliation": [], "family": "Al Sulaiman", "given": "Khalid", "sequence": "first" }, { "affiliation": [], "family": "Korayem", "given": "Ghazwa B.", "sequence": "additional" }, { "affiliation": [], "family": "Aljuhani", "given": "Ohoud", "sequence": "additional" }, { "affiliation": [], "family": "Altebainawi", "given": "Ali F.", "sequence": "additional" }, { "affiliation": [], "family": "Shawaqfeh", "given": "Mohammad S.", "sequence": "additional" }, { "affiliation": [], "family": "Alarfaj", "given": "Sumaiah J.", "sequence": "additional" }, { "affiliation": [], "family": "Alharbi", "given": "Reham A.", "sequence": "additional" }, { "affiliation": [], "family": "Ageeli", "given": "Mawaddah M.", "sequence": "additional" }, { "affiliation": [], "family": "Alissa", "given": "Abdulrahman", "sequence": "additional" }, { "affiliation": [], "family": "Vishwakarma", "given": "Ramesh", "sequence": "additional" }, { "affiliation": [], "family": "Ibrahim", "given": "Alnada", "sequence": "additional" }, { "affiliation": [], "family": "Alenazi", "given": "Abeer A.", "sequence": "additional" }, { "affiliation": [], "family": "Alghnam", "given": "Suliman", "sequence": "additional" }, { "affiliation": [], "family": "Alshehri", "given": "Nadiyah", "sequence": "additional" }, { "affiliation": [], "family": "Alshammari", "given": "Maqbulah M.", "sequence": "additional" }, { "affiliation": [], "family": "Alhubaishi", "given": "Alaa", "sequence": "additional" }, { "affiliation": [], "family": "Aldhaeefi", "given": "Mohammed", "sequence": "additional" }, { "affiliation": [], "family": "Alamri", "given": "Faisal F.", "sequence": "additional" }, { "affiliation": [], "family": "Syed", "given": "Yadullah", "sequence": "additional" }, { "affiliation": [], "family": "Khan", "given": "Raymond", "sequence": "additional" }, { "affiliation": [], "family": "Alalawi", "given": "Mai", "sequence": "additional" }, { "affiliation": [], "family": "Alanazi", "given": "Khalaf A.", "sequence": "additional" }, { "affiliation": [], "family": "Alresayes", "given": "Faisal S.", "sequence": "additional" }, { "affiliation": [], "family": "Albarqi", "given": "Khalid J.", "sequence": "additional" }, { "affiliation": [], "family": "Al Ghamdi", "given": "Ghassan", "sequence": "additional" } ], "container-title": "Frontiers in Medicine", "container-title-short": "Front. 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