Vitamin D Status and SARS-CoV-2 Infection and COVID-19 Clinical Outcomes
Front Public Health. 2021 Dec 22;9:736665. doi: 10.3389/fpubh.2021.736665. eCollection 2021.
Iacopo Chiodini 1 2, Davide Gatti 3, Davide Soranna 4, Daniela Merlotti 5, Christian Mingiano 5, Angelo Fassio 3, Giovanni Adami 3, Alberto Falchetti 6, Cristina Eller-Vainicher 7, Maurizio Rossini 3, Luca Persani 1 2, Antonella Zambon 4 8, Luigi Gennari 5 Italy
Background: Several studies suggest an association between serum 25-hydroxyvitamin D (25OHD) and the outcomes of Severe Acute Respiratory Syndrome Corona-Virus-2 (SARS-CoV-2) infection, in particular Coronavirus Disease-2019 (COVID-19) related severity and mortality. The aim of the present meta-analysis was to investigate whether vitamin D status is associated with the COVID-19 severity, defined as ARDS requiring admission to intensive care unit (ICU) or mortality (primary endpoints) and with the susceptibility to SARS-CoV-2 and COVID-19-related hospitalization (secondary endpoints).
Methods: A search in PubMed, ScienceDirect, Web of Science, Google Scholar, Scopus, and preprints repositories was performed until March 31th 2021 to identify all original observational studies reporting association measures, or enough data to calculate them, between Vitamin D status (insufficiency <75, deficiency <50, or severe deficiency <25 nmol/L) and risk of SARS-CoV-2 infection, COVID-19 hospitalization, ICU admission, or death during COVID-19 hospitalization.
Findings: Fifty-four studies (49 as fully-printed and 5 as pre-print publications) were included for a total of 1,403,715 individuals. The association between vitamin D status and SARS-CoV2 infection, COVID-19 related hospitalization, COVID-19 related ICU admission, and COVID-19 related mortality was reported in 17, 9, 27, and 35 studies, respectively.
Severe deficiency, deficiency and insufficiency of vitamin D were all associated with
- ICU admission (odds ratio [OR], 95% confidence intervals [95%CIs]: 2.63, 1.45-4.77; 2.16, 1.43-3.26; 2.83, 1.74-4.61, respectively),
- mortality (OR, 95%CIs: 2.60, 1.93-3.49; 1.84, 1.26-2.69; 4.15, 1.76-9.77, respectively),
- SARS-CoV-2 infection (OR, 95%CIs: 1.68, 1.32-2.13; 1.83, 1.43-2.33; 1.49, 1.16-1.91, respectively) and
- COVID-19 hospitalization (OR, 95%CIs 2.51, 1.63-3.85; 2.38, 1.56-3.63; 1.82, 1.43-2.33).
Considering specific subgroups (i.e., Caucasian patients, high quality studies, and studies reporting adjusted association estimates) the results of primary endpoints did not change.
Interpretations: Patients with low vitamin D levels present an increased risk of ARDS requiring admission to intensive care unit (ICU) or mortality due to SARS-CoV-2 infection and a higher susceptibility to SARS-CoV-2 infection and related hospitalization.
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Odds Ratio data in tabular form
Severe deficiency | deficiency | insufficiency | |
ICU admission | 2.63 | 2.16 | 2.83 |
Mortality | 2.60 | 1.84 | 4.15 |
Infection | 1.68 | 1.83 | 1.49 |
Founder of VitaminDWiki finds it strange that insufficiency has worse odds ratio than deficiency in the first 2 rows
VitaminDWiki - Vitamin D meta-analyses of Virus
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- COVID ICU 3X less-likely if take any amount and type of Vitamin D – meta-analysis Jan 2023
- COVID and Vitamin D: any amount of D, at any time, for any duration reduced ICU - meta-analysis Dec 2022
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- COVID-19 risk reduced by vitamin D supplementation – umbrella review of 7 meta-analysis – Oct 2021
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- Severe COVID-19 5X more likely if low vitamin D (23 studies) – 16th meta-analysis July 2021
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- COVID-19 patients who had supplemented with Vitamin D were 3X less likely to enter ICU – June 2021
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- Less likely to test positive for COVID-19 if higher Vitamin D – meta-analysis Jan 6, 2021
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- COVID-19 1.7X more likely to be severe if low Vitamin D - meta-analysis Oct 2020
- Low Vitamin D associated 1.8X increased risk of COVID-19 death in hospital – meta-analysis Nov 4, 2020
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- Prudent to consider that Vitamin D has a role in COVID-19 – meta-analysis – Aug 7, 2020
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- Hepatitis B patients have 2 ng lower level of Vitamin D – meta-analysis June 2019
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