Vitamin D and COVID-19 severity and related mortality: a prospective study in Italy

DOI record: { "DOI": "10.1186/s12879-021-06281-7", "ISSN": [ "1471-2334" ], "URL": "http://dx.doi.org/10.1186/s12879-021-06281-7", "abstract": "<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Vitamin D deficiency has been suggested to favor a poorer outcome of Coronavirus disease-19 (COVID-19). We aimed to assess if 25-hydroxyvitamin-D (25OHD) levels are associated with interleukin 6 (IL-6) levels and with disease severity and mortality in COVID-19.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We prospectively studied 103 in-patients admitted to a Northern-Italian hospital (age 66.1 ± 14.1 years, 70 males) for severely-symptomatic COVID-19. Fifty-two subjects with SARS-CoV-2 infection but mild COVID-19 symptoms (mildly-symptomatic COVID-19 patients) and 206 subjects without SARS-CoV-2 infection were controls. We measured 25OHD and IL-6 levels at admission and focused on respiratory outcome during hospitalization.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Severely-symptomatic COVID-19 patients had lower 25OHD levels (18.2 ± 11.4 ng/mL) than mildly-symptomatic COVID-19 patients and non-SARS-CoV-2-infected controls (30.3 ± 8.5 ng/mL and 25.4 ± 9.4 ng/mL, respectively,<jats:italic>p</jats:italic> &lt; 0.0001 for both comparisons). 25OHD and IL-6 levels were respectively lower and higher in severely-symptomatic COVID-19 patients admitted to intensive care Unit [(ICU), 14.4 ± 8.6 ng/mL and 43.0 (19.0–56.0) pg/mL, respectively], than in those not requiring ICU admission [22.4 ± 1.4 ng/mL,<jats:italic>p</jats:italic> = 0.0001 and 16.0 (8.0–32.0) pg/mL,<jats:italic>p</jats:italic> = 0.0002, respectively]. Similar differences were found when comparing COVID-19 patients who died in hospital [13.2 ± 6.4 ng/mL and 45.0 (28.0–99.0) pg/mL] with survivors [19.3 ± 12.0 ng/mL,<jats:italic>p</jats:italic> = 0.035 and 21.0 (10.5–45.9) pg/mL,<jats:italic>p</jats:italic> = 0.018, respectively). 25OHD levels inversely correlated with: i) IL-6 levels (ρ − 0.284,<jats:italic>p</jats:italic> = 0.004); ii) the subsequent need of the ICU admission [relative risk, RR 0.99, 95% confidence interval (95%CI) 0.98–1.00,<jats:italic>p</jats:italic> = 0.011] regardless of age, gender, presence of at least 1 comorbidity among obesity, diabetes, arterial hypertension, creatinine, IL-6 and lactate dehydrogenase levels, neutrophil cells, lymphocytes and platelets count; iii) mortality (RR 0.97, 95%CI, 0.95–0.99, p = 0.011) regardless of age, gender, presence of diabetes, IL-6 and C-reactive protein and lactate dehydrogenase levels, neutrophil cells, lymphocytes and platelets count.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>In our COVID-19 patients, low 25OHD levels were inversely correlated with high IL-6 levels and were independent predictors of COVID-19 severity and mortality.</jats:p></jats:sec>", "alternative-id": [ "6281" ], "article-number": "566", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "17 November 2020" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "3 June 2021" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "14 June 2021" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Ethics approval and consent to participate", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "The study was approved by the ethics committee of our Institution (Ethical Committee, Istituto Auxologico Italiano). The participants or their familiar, when needed as in the case of ICU admitted patients, gave written informed consent before taking part in the study." }, { "group": { "label": "Consent for publication", "name": "EthicsHeading" }, "name": "Ethics", "order": 3, "value": "Not applicable." }, { "group": { "label": "Competing interests", "name": "EthicsHeading" }, "name": "Ethics", "order": 4, "value": "All authors declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in this work; no other relationships or activities that could appear to have influenced this work." } ], "author": [ { "affiliation": [], "family": "Campi", "given": "Irene", "sequence": "first" }, { "affiliation": [], "family": "Gennari", "given": "Luigi", "sequence": "additional" }, { "affiliation": [], "family": "Merlotti", "given": "Daniela", "sequence": "additional" }, { "affiliation": [], "family": "Mingiano", "given": 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