Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among COVID-19 Patients in Pakistan
Muhammad Sohaib Asghar, Farah Yasmin, Kartik Dapke, Syed Muhammad Ismail Shah, Muhammad Daim Bin Zafar, Anosh Aslam Khan, Osama Mohiuddin, Salim Surani
The American Journal of Tropical Medicine and Hygiene, doi:10.4269/ajtmh.21-0577
The risk of acute respiratory tract infections is particularly pronounced in patients deficient in 25-hydroxyvitamin D (25(OH)D). With respect to COVID-19, there are conflicting evidence on the association of 25(OH)D levels with disease severity. We undertook this study to evaluate the 25(OH)D status in COVID-19 patients admitted in Karachi, Pakistan, and associated vitamin D deficiency with primary outcomes of mortality, length of stay, intubation, and frequency of COVID-19 symptoms. A total of 91 patients were evaluated for 25(OH)D status during their COVID-19 disease course. 25-hydroxyvitamin D levels were classified as deficient (, 10 ng/mL), insufficient (10-30 ng/mL), or sufficient (. 30 ng/mL). The study population comprised 68.1% males (N 5 62). The mean age was 52.6 6 15.7 years. Vitamin D deficiency was significantly associated with intensive care unit (ICU) admission (RR: 3.20; P 5 0.048), invasive ventilation (RR: 2.78; P 5 0.043), persistent pulmonary infiltrates (RR: 7.58; P , 0.001), and death (RR: 2.98; P , 0.001) on univariate Cox regression. On multivariate Cox regression, only death (RR: 2.13; P 5 0.046) and persistent pulmonary infiltrates (RR: 6.78; P 5 0.009) remained significant after adjustment for confounding factors. On Kaplan Meier curves, vitamin D deficient patients had persistent pulmonary infiltrates and a greater probability of requiring mechanical ventilation than patients with 25(OH)D $ 10 ng/mL. Mechanical ventilation had to be initiated early in the deficient group during the 30-day hospital stay (Chi-square: 4.565, P 5 0.033). Patients with 25(OH)D $ 10 ng/mL also demonstrated a higher probability of survival than those with 25(OH)D concentrations , 10 ng/mL. 25-hydroxyvitamin D deficient population had longer hospital stays and worse outcomes.
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DOI record:
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"abstract": "<jats:title>ABSTRACT.</jats:title>\n<jats:p>The risk of acute respiratory tract infections is particularly pronounced in patients deficient in 25-hydroxyvitamin D (25(OH)D). With respect to COVID-19, there are conflicting evidence on the association of 25(OH)D levels with disease severity. We undertook this study to evaluate the 25(OH)D status in COVID-19 patients admitted in Karachi, Pakistan, and associated vitamin D deficiency with primary outcomes of mortality, length of stay, intubation, and frequency of COVID-19 symptoms. A total of 91 patients were evaluated for 25(OH)D status during their COVID-19 disease course. 25-hydroxyvitamin D levels were classified as deficient (< 10 ng/mL), insufficient (10–30 ng/mL), or sufficient (> 30 ng/mL). The study population comprised 68.1% males (<jats:italic>N</jats:italic> = 62). The mean age was 52.6 ± 15.7 years. Vitamin D deficiency was significantly associated with intensive care unit (ICU) admission (RR: 3.20; <jats:italic>P</jats:italic> = 0.048), invasive ventilation (RR: 2.78; <jats:italic>P</jats:italic> = 0.043), persistent pulmonary infiltrates (RR: 7.58; <jats:italic>P</jats:italic> < 0.001), and death (RR: 2.98; <jats:italic>P</jats:italic> < 0.001) on univariate Cox regression. On multivariate Cox regression, only death (RR: 2.13; <jats:italic>P</jats:italic> = 0.046) and persistent pulmonary infiltrates (RR: 6.78; <jats:italic>P</jats:italic> = 0.009) remained significant after adjustment for confounding factors. On Kaplan Meier curves, vitamin D deficient patients had persistent pulmonary infiltrates and a greater probability of requiring mechanical ventilation than patients with 25(OH)D ≥ 10 ng/mL. Mechanical ventilation had to be initiated early in the deficient group during the 30-day hospital stay (Chi-square: 4.565, <jats:italic>P</jats:italic> = 0.033). Patients with 25(OH)D ≥ 10 ng/mL also demonstrated a higher probability of survival than those with 25(OH)D concentrations < 10 ng/mL. 25-hydroxyvitamin D deficient population had longer hospital stays and worse outcomes.</jats:p>",
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