Serum 25(OH)D Level on Hospital Admission Associated With COVID-19 Stage and Mortality
De Smet et al.,
Serum 25(OH)D Level on Hospital Admission Associated With COVID-19 Stage and Mortality,
American Journal of Clinical Pathology, doi:10.1093/ajcp/aqaa252
Retrospective 186 hospitalized patients in Belgium showing that 59% of patients were vitamin D deficient, and that non-vitamin D deficient patients had significantly lower mortality risk, RR 0.26, p = 0.015.
risk of death, 70.1% lower, RR 0.30, p = 0.02, high D levels 7 of 77 (9.1%), low D levels 20 of 109 (18.3%), adjusted per study, odds ratio converted to relative risk, >20ng/mL.
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De Smet et al., 25 Nov 2020, retrospective, Belgium, peer-reviewed, 5 authors.
Abstract: AJCP / Original Article
Serum 25(OH)D Level on Hospital Admission Associated
With COVID-19 Stage and Mortality
Dieter De Smet, MD,1 Kristof De Smet, MD,2 Pauline Herroelen, MSc,1 Stefaan Gryspeerdt, MD,2 and
Geert A. Martens, MD, PhD1,3,4,
From the 1AZ Delta Medical Laboratories and 2Department of Radiology, AZ Delta General Hospital, Roeselare, Belgium; 3VUB Metabolomics
Platform, Brussels Free University, Brussels, Belgium; and 4Department of Biomolecular Medicine, Ghent University, Ghent, Belgium.
Am J Clin Pathol March 2021;155:381-388
DOI: 10.1093/AJCP/AQAA252
ABSTRACT
Objectives: Vitamin D deficiency was previously correlated
with incidence and severity of coronavirus disease 2019
(COVID-19). We investigated the association between serum
25-hydroxyvitamin D (25(OH)D) level on admission and
radiologic stage and outcome of COVID-19 pneumonia.
Methods: A retrospective observational trial was done on
186 severe acute respiratory syndrome coronavirus 2 (SARSCoV-2)–infected individuals hospitalized from March 1, 2020,
to April 7, 2020, with combined chest computed tomography
(CT) and 25(OH)D measurement on admission. Multivariate
regression analysis was performed to study if vitamin D
deficiency (25(OH)D <20 ng/mL) correlates with survival
independently of confounding comorbidities.
Results: Of the patients with COVID-19, 59% were
vitamin D deficient on admission: 47% of females and
67% of males. In particular, male patients with COVID19 showed progressively lower 25(OH)D with advancing
radiologic stage, with deficiency rates increasing from
55% in stage 1 to 74% in stage 3. Vitamin D deficiency on
admission was not confounded by age, ethnicity, chronic
lung disease, coronary artery disease/hypertension, or
diabetes and was associated with mortality (odds ratio
[OR], 3.87; 95% confidence interval [CI], 1.30-11.55),
independent of age (OR, 1.09; 95% CI, 1.03-1.14),
chronic lung disease (OR, 3.61; 95% CI, 1.18-11.09),
and extent of lung damage expressed by chest CT severity
score (OR, 1.12; 95% CI, 1.01-1.25).
Conclusions: Low 25(OH)D levels on admission are
associated with COVID-19 disease stage and mortality.
© American Society for Clinical Pathology, 2020. All rights reserved.
For permissions, please e-mail: journals.permissions@oup.com
Key Points
• A remarkably high fraction (59%) of patients with coronavirus disease
2019 (COVID-19) are vitamin D deficient (25(OH)D <20 ng/mL) on
admission. Deficiency was most pronounced in men with advanced
radiologic stages of COVID-19 pneumonia.
• Vitamin D deficiency on admission was associated with COVID-19
mortality with an odds ratio of 3.87, independent of age, chronic lung
disease, coronary artery disease, hypertension, or diabetes.
In a subset of severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) infections, excessive recruitment of proinflammatory cells and cytokine release contribute to alveolar and endothelial damage,
triggering a vicious cycle that evolves toward severe coronavirus disease 2019 (COVID-19).1,2 Beside its role in
calcium metabolism, 1,25-dihydroxyvitamin D is a pleiotropic regulator of the immune system.3-5 It stimulates
the expression of cathelicidins and β-defensins in respiratory epithelia as a barrier to pathogen invasion.6,7
It acts as a protolerogenic and anti-inflammatory cytokine by inhibiting T helper 1 (Th1) proliferation and
switching Th1 CD4 T cells and M1-polarized macrophages toward a type II immunity. Vitamin D deficiency (25-hydroxyvitamin D..
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