Association of Vitamin D Prescribing and Clinical Outcomes in Adults Hospitalized with COVID-19
Fairfield et al.,
Association of Vitamin D Prescribing and Clinical Outcomes in Adults Hospitalized with COVID-19,
Nutrients, doi:10.3390/nu14153073
N3C retrospective showing higher risk with vitamin D treatment for hospitalized patients. As noted by authors,
confounding by indication may be significant. The more extreme ventilation result, which is a significant outlier among all studies, is consistent with such confounding. Timing, dose, and duration of treatment were not used.
This study is excluded in the after exclusion results of meta
analysis:
substantial unadjusted
confounding by indication likely.
risk of death, 8.9% higher, RR 1.09, p < 0.001, treatment 3,653 of 28,993 (12.6%), control 13,185 of 129,842 (10.2%), odds ratio converted to relative risk.
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risk of mechanical ventilation, 40.8% higher, RR 1.41, p < 0.001, treatment 4,897 of 28,993 (16.9%), control 15,520 of 129,842 (12.0%), odds ratio converted to relative risk.
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Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
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Fairfield et al., 26 Jul 2022, retrospective, USA, peer-reviewed, 10 authors, study period 1 January, 2020 - 31 July, 2021, dosage not specified.
Contact:
kathleen.fairfield@mainehealth.org (corresponding author), kimberly.murray@mainehealth.org, susan.santangelo@mainehealth.org, clifford.rosen@mainehealth.org, alfred.anzalone@unmc.edu, william-beasley@ouhsc.edu, makhodaverdi@hsc.wvu.edu, slhodder@hsc.wvu.edu, owlhealthworks@gmail.com.
Abstract: nutrients
Article
Association of Vitamin D Prescribing and Clinical Outcomes in
Adults Hospitalized with COVID-19
Kathleen M. Fairfield 1,2, *, Kimberly A. Murray 1 , A. Jerrod Anzalone 3 , William Beasley 4 ,
Maryam Khodaverdi 5 , Sally L. Hodder 5 , Jeremy Harper 6 , Susan Santangelo 1,2 , Clifford J. Rosen 1,2
and on behalf of the N3C Consortium †
1
2
3
4
5
6
*
†
Citation: Fairfield, K.M.; Murray,
K.A.; Anzalone, A.J.; Beasley, W.;
Khodaverdi, M.; Hodder, S.L.;
Harper, J.; Santangelo, S.; Rosen, C.J.;
on behalf of the N3C Consortium.
Association of Vitamin D Prescribing
and Clinical Outcomes in Adults
Hospitalized with COVID-19.
Nutrients 2022, 14, 3073. https://
doi.org/10.3390/nu14153073
Academic Editor: Bruce W. Hollis
Received: 22 June 2022
Accepted: 21 July 2022
Published: 26 July 2022
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
published maps and institutional affiliations.
MaineHealth Institute for Research, Portland, ME 04074, USA; kimberly.murray@mainehealth.org (K.A.M.);
susan.santangelo@mainehealth.org (S.S.); clifford.rosen@mainehealth.org (C.J.R.)
Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA;
alfred.anzalone@unmc.edu
Biomedical and Behavioral Methodology Core, University of Oklahoma, Norman, OK 73019, USA;
william-beasley@ouhsc.edu
West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine,
Morgantown, WV 26506, USA; makhodaverdi@hsc.wvu.edu (M.K.); slhodder@hsc.wvu.edu (S.L.H.)
Owl Health Works LLC, Indianapolis, IN 46278, USA; owlhealthworks@gmail.com
Correspondence: kathleen.fairfield@mainehealth.org
N3C Consortial contributors: Jeremy Harper, Christopher G. Chute, Carolyn Bramante, Melissa A. Handel,
Richard A. Moffitt.
Abstract: Abstract: 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..
Late treatment
is less effective
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