The Interaction of Vitamin D and Corticosteroids: A Mortality Analysis of 26,508 Veterans Who Tested Positive for SARS-CoV-2
Efird et al.,
The Interaction of Vitamin D and Corticosteroids: A Mortality Analysis of 26,508 Veterans Who Tested Positive..,
International Journal of Environmental Research and Public Health, doi:10.3390/ijerph19010447
Retrospective 26,508 COVID+ veterans in USA, showing lower mortality with vitamin D use after testing positive (defined as being administered ≥7 days or half of the survival time within 2 weeks after testing), with statistical significance for hospitalized patients.
risk of death, 48.9% lower, RR 0.51, p = 0.10, treatment 11 of 544 (2.0%), control 413 of 15,794 (2.6%), adjusted per study, non-hospitalized patients, vitamin D + no corticosteroids vs. no vitamin D + no corticosteroids.
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risk of death, 54.5% lower, RR 0.45, p = 0.02, treatment 11 of 192 (5.7%), control 553 of 4,340 (12.7%), NNT 14, adjusted per study, hospitalized patients, vitamin D + no corticosteroids vs. no vitamin D + no corticosteroids.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Efird et al., 31 Dec 2021, retrospective, USA, peer-reviewed, 10 authors, study period 1 March, 2020 - 10 September, 2020, dosage varies.
Abstract: International Journal of
Environmental Research
and Public Health
Article
The Interaction of Vitamin D and Corticosteroids:
A Mortality Analysis of 26,508 Veterans Who Tested
Positive for SARS-CoV-2
Jimmy T. Efird 1, *, Ethan J. Anderson 2 , Charulata Jindal 3 , Thomas S. Redding 1 , Andrew D. Thompson 1 ,
Ashlyn M. Press 1 , Julie Upchurch 1 , Christina D. Williams 1,4,5 , Yuk Ming Choi 6 and Ayako Suzuki 1,7,8
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Citation: Efird, J.T.; Anderson, E.J.;
Jindal, C.; Redding, T.S.; Thompson,
A.D.; Press, A.M.; Upchurch, J.;
Williams, C.D.; Choi, Y.M.; Suzuki, A.
The Interaction of Vitamin D and
Corticosteroids: A Mortality Analysis
of 26,508 Veterans Who Tested
Positive for SARS-CoV-2. Int. J.
Environ. Res. Public Health 2022, 19,
447. https://doi.org/10.3390/
ijerph19010447
Academic Editor: Oliver Grundmann
Received: 5 December 2021
Cooperative Studies Program Epidemiology Center, Durham VA Health Care System,
Durham, NC 27705, USA; thomas.redding28@va.gov (T.S.R.); andrew.thompson3@va.gov (A.D.T.);
ashlyn.press@va.gov (A.M.P.); julie.upchurch@va.gov (J.U.); christina.williams4@va.gov (C.D.W.);
ayako.suzuki@duke.edu (A.S.)
College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA; ethan-anderson@uiowa.edu
Harvard Medical School, Harvard University, Boston, MA 02115, USA; charujindal@gmail.com
Department of Medicine, Duke University, Durham, NC 27710, USA
Duke Cancer Institute, Duke University, Durham, NC 27710, USA
Signify Health, Dallas, TX 75244, USA; ychoi@signifyhealth.com
Division of Gastroenterology, Duke University, Durham, NC 27710, USA
The Division of Gastroenterology, Durham VA Medical Center, Durham, NC 27705, USA
Correspondence: jimmy.efird@va.gov; Tel.: +1-(650)-248-8282
Abstract: This data-based cohort consisted of 26,508 (7%) United States veterans out of the 399,290
who tested positive for SARS-CoV-2 from 1 March to 10 September 2020. We aimed to assess the
interaction of post-index vitamin D (Vit D) and corticosteroid (CRT) use on 30-day mortality among
hospitalized and non-hospitalized patients with coronavirus disease 2019 (COVID-19). Combination
Vit D and CRT drug use was assessed according to four multinomial pairs (−|+, −|−, +|+, +|−).
Respective categorical effects were computed on a log-binomial scale as adjusted relative risk (aRR).
Approximately 6% of veterans who tested positive for SARS-CoV-2 died within 30 days of their index
date. Among hospitalized patients, a significantly decreased aRR was observed for the use of Vit D in
the absence of CRTs relative to patients who received CRTs but not Vit D (aRR = 0.30; multiplicity corrected, p = 0.0004). Among patients receiving systemically administered CRTs (e.g., dexamethasone),
the use of Vit D was associated with fewer deaths in hospitalized patients (aRR = 0.51) compared with
non-hospitalized patients (aRR = 2.5) (P-for-Interaction = 0.0071). Evaluating the effect of modification
of these compounds in the context of hospitalization may aid in the management of COVID-19 and
provide a better understanding of the pathophysiological mechanisms underlying this and future
infectious disease outbreaks.
Accepted: 28 December 2021
Published: 31 December 2021
Publisher’s Note: MDPI stays neutral
Keywords: anti-inflammatory; corticosteroids; COVID-19; cytokine storm; SARS-CoV-2; vitamin D;
veterans
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