VITAMIN D TREATMENT IS ASSOCIATED WITH REDUCED RISK OF MORTALITY IN PATIENTS WITH COVID-19: A CROSS-SECTIONAL MULTI-CENTRE OBSERVATIONAL STUDY
Ling Mbchb, Eleanor Broad Mbchb, Rebecca Murphy Mbchb, MD Joseph M Pappachan, Satveer Pardesi-Newton Bm, Marie-France Kong, Professor Edward B Jude
Background: The 2019 novel coronavirus disease (Covid-19) worldwide pandemic has posed the most substantial and severe public health issue for several generations, and therapeutic options for it have not yet been optimised. Vitamin D has been proposed in the pharmacological management of Covid-19 by various sources. This study aimed to determine whether Covid-19 disease outcomes were affected by vitamin D status, and to elucidate any predictors of Covid-19 outcomes. Methods: Patients hospitalised with Covid-19 were opportunistically recruited from three different UK hospitals and their data were collected. Logistic regression was used to determine any relationships between vitamin D status and various predictors, including mortality and ventilation, and to determine any relationships between mortality, ventilation, and various predictors. Findings: Vitamin D status was not associated with any outcomes of Covid-19 investigated, following adjustment for age and sex. However, treatment with vitamin D was significantly associated with a reduced risk of death, following adjustment for age and sex (OR adj 0•48, 95% CI 0•32 -0•70, p = 1•79x10 -4 ). This relationship remained significant when also adjusted for baseline vitamin D levels (OR adj 0•47, 95% CI 0•33 -0•70, p = 1•27x10 -4 ). Interpretation: Treatment with vitamin D, regardless of baseline serum vitamin D levels, appears to be associated with a reduced risk of mortality in acute in-patients admitted with Covid-19. Further work on large population studies needs to be carried out to determine adequate serum levels of vitamin D, as well as multi-dose clinical trials of vitamin D treatment to assess maximum efficacy.
CONFLICT OF INTERESTS The authors have no conflicts of interest.
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"abstract": "<jats:p>The worldwide pandemic of 2019 novel coronavirus disease (COVID-19) has posed the most substantial and severe public health issue for several generations, and therapeutic options have not yet been optimised. Vitamin D (in its “parent” form, cholecalciferol) has been proposed in the pharmacological management of COVID-19 by various sources. We aimed to determine whether COVID-19 mortality was affected by serum 25-hydroxyvitamin D (25(OH)D) levels, vitamin D status, or cholecalciferol therapy, and to elucidate any other predictors of COVID-19 mortality. Patients hospitalised with COVID-19 were opportunistically recruited from three UK hospitals, and their data were collected retrospectively. Logistic regression was used to determine any relationships between COVID-19 mortality and potential predictors, including 25(OH)D levels and cholecalciferol booster therapy. A total of 986 participants with COVID-19 were studied, of whom 151 (16.0%) received cholecalciferol booster therapy. In the primary cohort of 444 patients, cholecalciferol booster therapy was associated with a reduced risk of COVID-19 mortality, following adjustment for potential confounders (ORadj 0.13, 95% CI 0.05–0.35, p < 0.001). This finding was replicated in a validation cohort of 541 patients (ORadj 0.38, 95% CI 0.17–0.84, p = 0.018). In this observational study, treatment with cholecalciferol booster therapy, regardless of baseline serum 25(OH)D levels, appears to be associated with a reduced risk of mortality in acute in-patients admitted with COVID-19. Further work with large population studies needs to be carried out to determine adequate serum 25(OH)D levels, as well as multi-dose clinical trials of cholecalciferol therapy to assess maximum efficacy.</jats:p>",
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