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All COVID-19 patients had low vitamin D, the lowest were more likely to die – Feb 18, 2021

Low Vitamin D Status at Admission as a Risk Factor for Poor Survival in Hospitalized Patients With COVID-19: An Italian Retrospective Study

J Am Coll Nutr . 2021 Feb 18;1-16. doi: 10.1080/07315724.2021.1877580.
Marco Infante 1 2 3, Andrea Buoso 4 5, Massimo Pieri 6 7, Santina Lupisella 6, Marzia Nuccetelli 6, Sergio Bernardini 6 7, Andrea Fabbri 1, Marco Iannetta 4 5, Massimo Andreoni 4 5, Vittorio Colizzi 8, Maria Morello 6 7

Objective: Preliminary findings suggest a relationship between lower serum 25-hydroxyvitamin D 25(OH)D levels and incidence and severity of COVID-19. The aim of this study was to evaluate the relationship between vitamin D status at admission and different markers of inflammation, coagulation, and sepsis in hospitalized patients with COVID-19.

Method: We conducted a retrospective study on 137 consecutive patients with SARS-CoV-2 infection and available data on serum 25(OH)D levels, who were admitted to our Institution between March 1 and April 30, 2020. Patients were divided into two groups: survivors (n = 78; 57%) and non-survivors (n = 59; 43%).

Results: At admission, all patients showed hypovitaminosis D. Median total serum 25(OH)D levels at admission were significantly higher in survivors than non-survivors (12 ng/mL vs 8 ng/mL; p < 0.01).
Non-survivors exhibited significantly higher median levels of

  • white blood cell (WBC) count,
  • neutrophil-to-lymphocyte count ratio (NLR),
  • high-sensitivity C-reactive protein (hsCRP),
  • ferritin,
  • interleukin 6 (IL-6),
  • D-dimer,
  • fibrinogen, and
  • procalcitonin (PCT)

compared to survivors at three different time points during hospitalization. In a multivariate analysis performed by a logistic regression model, serum 25(OH)D levels were significantly inversely associated with risk of COVID-19-related in-hospital mortality (odds ratio, 0.91; 95% confidence interval, 0.85-0.98; p = 0.01). According to receiver operating characteristic curve analysis, hsCRP, NLR, ferritin, and D-dimer were the best predictive biomarkers for poor prognosis of COVID-19, whereas IL-6, PCT, fibrinogen, 25(OH)D, WBC count, and tumor necrosis factor alpha (TNF-α) may serve as supportive biomarkers for worse clinical course of the disease.

Conclusions: We found a markedly high prevalence (100%) of hypovitaminosis D in patients admitted to hospital with COVID-19, suggesting a possible role of low vitamin D status in increasing the risk of SARS-CoV-2 infection and subsequent hospitalization. The inverse association between serum 25(OH)D levels and risk of in-hospital mortality observed in our cohort suggests that a lower vitamin D status upon admission may represent a modifiable and independent risk factor for poor prognosis in COVID-19.


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