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0 0.5 1 1.5 2+ Mortality -9% Improvement Relative Risk Ventilation -41% Fairfield et al. Vitamin D for COVID-19 LATE Is late treatment with vitamin D beneficial for COVID-19? Retrospective 158,835 patients in the USA (January 2020 - July 2021) Higher mortality (p<0.0001) and ventilation (p<0.0001) Fairfield et al., Nutrients, doi:10.3390/nu14153073 Favors vitamin D Favors control
Association of Vitamin D Prescribing and Clinical Outcomes in Adults Hospitalized with COVID-19
Fairfield et al., Nutrients, doi:10.3390/nu14153073
Fairfield et al., Association of Vitamin D Prescribing and Clinical Outcomes in Adults Hospitalized with COVID-19, Nutrients, doi:10.3390/nu14153073
Jul 2022   Source   PDF  
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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.
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.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fairfield et al., 26 Jul 2022, retrospective, USA, peer-reviewed, 10 authors, study period 1 January, 2020 - 31 July, 2021, dosage not specified.
Contact: (corresponding author),,,,,,,,
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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:// 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; (K.A.M.); (S.S.); (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; Biomedical and Behavioral Methodology Core, University of Oklahoma, Norman, OK 73019, USA; West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, WV 26506, USA; (M.K.); (S.L.H.) Owl Health Works LLC, Indianapolis, IN 46278, USA; Correspondence: 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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