Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among COVID-19 Patients in Pakistan
Asghar et al.,
Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among COVID-19 Patients in Pakistan,
Am. J. Trop. Med. Hyg., doi:10.4269/ajtmh.21-0577
Retrospective 91 hospitalized patients in Pakistan, showing vitamin D deficiency associated with mortality in multivariate Cox regression.
risk of death, 53.1% lower, HR 0.47, p = 0.046, high D levels (≥10ng/mL) 73, low D levels (<10ng/mL) 18, inverted to make HR<1 favor high D levels (≥10ng/mL), multivariate Cox regression.
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risk of mechanical ventilation, 19.4% lower, HR 0.81, p = 0.32, high D levels (≥10ng/mL) 5 of 73 (6.8%), low D levels (<10ng/mL) 6 of 18 (33.3%), NNT 3.8, adjusted per study, inverted to make HR<1 favor high D levels (≥10ng/mL), multivariate Cox regression.
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risk of ICU admission, 32.9% lower, HR 0.67, p = 0.54, high D levels (≥10ng/mL) 73, low D levels (<10ng/mL) 18, inverted to make HR<1 favor high D levels (≥10ng/mL), multivariate Cox regression.
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Asghar et al., 10 Nov 2021, retrospective, Pakistan, peer-reviewed, 8 authors.
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Am. J. Trop. Med. Hyg., 00(00), 2021, pp. 1–6
doi:10.4269/ajtmh.21-0577
Copyright © 2021 by The American Society of Tropical Medicine and Hygiene
Evaluation of Vitamin-D Status and Its Association with Clinical Outcomes Among
COVID-19 Patients in Pakistan
Muhammad Sohaib Asghar,1* Farah Yasmin,2 Kartik Dapke,3 Syed Muhammad Ismail Shah,4 Muhammad Daim Bin Zafar,2
Anosh Aslam Khan,2 Osama Mohiuddin,2 and Salim Surani5
1
Department of Internal Medicine, Dow University of Health Sciences–Ojha Campus, Karachi, Pakistan; 2Department of Internal Medicine,
Dow University of Health Sciences, Karachi, Pakistan; 3Indira Gandhi Government Medical College, Nagpur, India; 4Department of Internal
Medicine, Ziauddin Medical University, Karachi, Pakistan; 5Adjunct Clinical Professor of Medicine and Pharmacology, Texas A&M
University, College Station, Texas
Abstract. 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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