Association of Vitamin D Prescribing and Clinical Outcomes in Adults Hospitalized with COVID-19
Kathleen M Fairfield, Kimberly A Murray, A Jerrod Anzalone, William Beasley, Maryam Khodaverdi, Sally L Hodder, Jeremy Harper, Susan Santangelo, Clifford J Rosen
Nutrients, doi:10.3390/nu14153073
BackgroundIt is unclear whether vitamin D benefits inpatients with COVID-19. Objective: To examine the relationship between vitamin D and COVID-19 outcomes. Design: Cohort study. Setting: National COVID Cohort Collaborative (N3C) database. Patients: 158,835 patients with confirmed COVID-19 and a sub-cohort with severe disease (n = 81,381) hospitalized between 1 January 2020 and 31 July 2021. Methods: We identified vitamin D prescribing using codes for vitamin D and its derivatives. We created a sub-cohort defined as having severe disease as those who required mechanical ventilation or extracorporeal membrane oxygenation (ECMO), had hospitalization >5 days, or hospitalization ending in death or hospice. Using logistic regression, we adjusted for age, sex, race, BMI, Charlson Comorbidity Index, and urban/rural residence, time period, and study site. Outcomes of interest were death or transfer to hospice, longer length of stay, and mechanical ventilation/ECMO. Results: Patients treated with vitamin D were older, had more comorbidities, and higher BMI compared with patients who did not receive vitamin D. Vitamin D treatment was associated with an increased odds of death or referral for hospice (adjusted odds ratio (AOR) 1.10: 95% CI 1.05-1.14), hospital stay >5 days (AOR 1.78: 95% CI 1.74-1.83), and increased odds of mechanical ventilation/ECMO (AOR 1.49: 95% CI 1.44-1.55). In the sub-cohort of severe COVID-19, vitamin D decreased the odds of death or hospice (AOR 0.90, 95% CI 0.86-0.94), but increased the odds of hospital stay longer >5 days (AOR 2.03, 95% CI 1.87-2.21) and mechanical ventilation/ECMO (AOR 1.16, 95% CI 1.12-1.21). Limitations: Our findings could reflect more aggressive treatment due to higher severity. Conclusion: Vitamin D treatment was associated with greater odds of extended hospitalization, mechanical ventilation/ECMO, and death or hospice referral.
Author Contributions: Conceptualization, K.M.F., C.J.R., S.L.H. and K.A.M.; methodology, K.M.F., K.A.M., W.B. and C.J.R.; validation, J.H., W.B., A.J.A. and N3C Consortium; formal analysis, K.A.M., M.K., A.J.A. and K.M.F.; investigation, C.J.R. and S.L.H.; resources, S.S.; writing-original draft preparation, K.M.F. and K.A.M.; writing-review and editing, C.J.R. and S.S.; project administration, K.A.M.; funding acquisition, C.J.R., S.L.H. and S.S. All authors have read and agreed to the published version of the manuscript.
Funding: The project described was supported by the National Institute of General Medical Sciences, 5U54GM104942-04. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Authorship was determined using ICMJE recommendations.
Institutional Review Board Statement: The N3C data transfer to NCATS is performed under a Johns Hopkins University Reliance Protocol # IRB00249128 or individual site agreements with NIH. The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board above. Informed Consent Statement: Patient consent was waived due to the fact this is a retrospective observational study using data from electronic medical records, and obtaining consent was not possible. Data Availability Statement: All diagnostic, medication, procedure, and laboratory concepts used in this study are available in Supplementary Table S7 . Raw code..
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'abstract': '<jats:p>It is unclear whether vitamin D benefits inpatients with COVID-19. Objective: To '
'examine the relationship between vitamin D and COVID-19 outcomes. Design: Cohort study. '
'Setting: National COVID Cohort Collaborative (N3C) database. Patients: 158,835 patients with '
'confirmed COVID-19 and a sub-cohort with severe disease (n = 81,381) hospitalized between 1 '
'January 2020 and 31 July 2021. Methods: We identified vitamin D prescribing using codes for '
'vitamin D and its derivatives. We created a sub-cohort defined as having severe disease as '
'those who required mechanical ventilation or extracorporeal membrane oxygenation (ECMO), had '
'hospitalization >5 days, or hospitalization ending in death or hospice. Using logistic '
'regression, we adjusted for age, sex, race, BMI, Charlson Comorbidity Index, and urban/rural '
'residence, time period, and study site. Outcomes of interest were death or transfer to '
'hospice, longer length of stay, and mechanical ventilation/ECMO. Results: Patients treated '
'with vitamin D were older, had more comorbidities, and higher BMI compared with patients who '
'did not receive vitamin D. Vitamin D treatment was associated with an increased odds of death '
'or referral for hospice (adjusted odds ratio (AOR) 1.10: 95% CI 1.05–1.14), hospital stay '
'>5 days (AOR 1.78: 95% CI 1.74–1.83), and increased odds of mechanical ventilation/ECMO '
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'odds of death or hospice (AOR 0.90, 95% CI 0.86–0.94), but increased the odds of hospital '
'stay longer >5 days (AOR 2.03, 95% CI 1.87–2.21) and mechanical ventilation/ECMO (AOR '
'1.16, 95% CI 1.12–1.21). Limitations: Our findings could reflect more aggressive treatment '
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