Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness
Amiel A Dror, Nicole Morozov, Amani Daoud, Yoav Namir, Orly Yakir, Yair Shachar, Mark Lifshitz, Ella Segal, Lior Fisher, Matti Mizrachi, Netanel Eisenbach, Doaa Rayan, Maayan Gruber, Amir Bashkin, Edward Kaykov, Masad Barhoum, Michael Edelstein, Eyal Sela
PLOS ONE, doi:10.1371/journal.pone.0263069
Objective Studies have demonstrated a potential correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This retrospective study examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2.
Participants The records of individuals admitted between April 7 th , 2020 and February 4 th , 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel, with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) were searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test.
Design Patients admitted to GMC with COVID-19 were categorized according to disease severity and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity was ascertained utilizing a multivariable regression analysis. To isolate the possible influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a cosinor model was used.
Results Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection. A lower vitamin D status was more common in patients with the severe or critical disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 ng/mL [34.3%] p
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'abstract': '<jats:sec id="sec001">\n'
'<jats:title>Objective</jats:title>\n'
'<jats:p>Studies have demonstrated a potential correlation between low vitamin D status and '
'both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This '
'retrospective study examines if, and to what degree, a relationship exists between '
'pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality '
'due to SARS-CoV-2.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec002">\n'
'<jats:title>Participants</jats:title>\n'
'<jats:p>The records of individuals admitted between April 7<jats:sup>th</jats:sup>, 2020 and '
'February 4<jats:sup>th</jats:sup>, 2021 to the Galilee Medical Center (GMC) in Nahariya, '
'Israel, with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) were '
'searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR '
'test.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec003">\n'
'<jats:title>Design</jats:title>\n'
'<jats:p>Patients admitted to GMC with COVID-19 were categorized according to disease severity '
'and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between '
'four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity '
'was ascertained utilizing a multivariable regression analysis. To isolate the possible '
'influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a '
'cosinor model was used.</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec004">\n'
'<jats:title>Results</jats:title>\n'
'<jats:p>Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 '
'infection. A lower vitamin D status was more common in patients with the severe or critical '
'disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 '
'ng/mL [34.3%] <jats:italic>p</jats:italic> < 0.001). Patients with vitamin D deficiency '
'(<20 ng/mL) were 14 times more likely to have severe or critical disease than patients '
'with 25(OH)D ≥40 ng/mL (odds ratio [OR], 14; 95% confidence interval [CI], 4 to 51; '
'<jats:italic>p</jats:italic> < 0.001).</jats:p>\n'
'</jats:sec>\n'
'<jats:sec id="sec005">\n'
'<jats:title>Conclusions</jats:title>\n'
'<jats:p>Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was '
'associated with increased disease severity and mortality.</jats:p>\n'
'</jats:sec>',
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