5.8 X more likely to die of COVID-19 if low vitamin D - Systematic Review Dec 3, 2020

Effect of Vitamin D deficiency on COVID-19 status: A systematic review

PrePrint doi: https://doi.org/10.1101/2020.12.01.20242313
Pranta Das, Nandeeta Samad, Bright Opoku Ahinkorah, Prince Peprah, Aliu Mohammed, Abdul-Aziz Seidu

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Background: One major micronutrient known to have a possible protective effect against COVID-19 disease is vitamin D. This systematic review sought to identify and synthesis available evidence to aid the understanding of the possible effect of vitamin D deficiency on COVID-19 status and health outcomes in COVID-19 patients.

Methods: Three databases PubMed, ScienceDirect, and Google Scholar were searched systematically to obtain English language journal article published within 1/12/2019 and 3/11/2020. The search consisted of the terms ("Vitamin D," OR "25‐Hydroxyvitamin D," OR "Low Vitamin D.") AND ("COVID-19" OR "2019-nCoV" OR "Coronavirus" OR "SARS-CoV-2") AND ("disease severity" OR "IMV" OR "ICU admission" OR "mortality" OR "hospitalization" OR "infection"). We followed the recommended PRISMA guidelines in executing this study. After going through the screening of the articles, eleven articles were included in the review.

Findings: Almost all the included studies reported a positive association between Vitamin D sufficiency and COVID-19 status and health outcomes. Vitamin D deficient patients (< 25 ng/mL) are 5.84 times [aOR=6.84, p=0.01] more likely to die from COVID-19 compared to the vitamin D sufficient people. Another study also found that Vitamin D deficiency is associated with higher risk of death with Hazard ratio (HR) 14.73, p<0.001 *. Vitamin D deficient (<12 ng/mL) people were 2.2 times [aOR=3.2, p=0.07] more likely to develop severe COVID-19 after adjusting for age, gender, obesity, cardiac disease, and kidney disease compared to the vitamin D sufficient people. One study found that after controlling for confounders, patients with low 25(OH)D (<30 ng/mL) level are more likely [aOR=1.45, p=<0.001] to be COVID-19 infected compared to the patients with 25(OH)D level >=30 ng/mL.

Conclusion: Findings from the study included suggest Vitamin D may serve as a mitigating effect for covid-19 infection, severity and mortality. We recommend the need to encourage people to eat foods rich in vitamin D such as fish, red meat, liver and egg yolks whiles at the same time providing vitamin D supplements for individuals with COVID-19 in order to boost their immune systems.

Table 2: Findings from the studies

Abrishami et al., 2020|

• The probability of death in patients with vitamin D deficiency [defined as 25(OH)D concentration < 25 ng/mL] was 34.6% compared with 6.4% in patients with sufficient vitamin D levels (P = 0.003).
• Odds of death was significantly higher in vitamin D deficient patients (< 25 ng/mL) [aOR=6.84, p=0.01] in comparison with discharged patients.

Maghbooli et al., 2020

• Severe disease infection was more prevalent in vitamin D deficiency patients compared to vitamin D sufficiency patients (77.2% vs 63.6%)
• patients who had a 25(OH)D<30 ng/mL that is vitamin D deficient had more risk [RR=1.59, p=0.02] of having severe disease infection compared to the patients who had 25(OH)D>=30 ng/mL that is vitamin D sufficient.

Radujkovic et al., 2020

• Vitamin D deficiency was associated with higher risk of death (HR= 14.73, p=<0.001)

Hastie et al., 2020

• Vitamin D deficiency univariably has significant effect on COVID-19 infection which is deficient people are more likely to be positive [OR=1.37, p=0.011]. But vitamin D deficiency has no significant impact on COVID-19 infection after adjusting for confounders.

Otros et al., 2020

• After adjusting for age, gender, obesity, and severe CKD, the odds ratio for Vitamin D deficiency was 3.2 (95 % CI: 0.9-11.4), p = 0.070

Merzon et al., 2020

• The mean plasma vitamin D level was significantly lower among those who tested positive than negative for COVID-19 [19.00 ng/mL vs. 20.55]
• After controlling for the confounders, patients with low 25(OH)D (<30 ng/mL) level were more likely [aOR=1.45, p=<0.001] to be COVID-19 infected compared to the patients with 25(OH)D level >=30 ng/mL.

Meltzer et al., 2020

• Patients with likely deficient vitamin D status at the time of COVID-19 testing had an increased relative risk of testing positive for COVID-19 (relative risk, 1.77; 95%CI, 1.12-2.81; P =.02) compared with patients with likely sufficient status at the time of COVID-19 testing, for an estimated mean rate in the deficient group of 21.6% vs 12.2% in the sufficient group

Ye et al., 2020

• The serum 25(OH)D levels in COVID-19 patients (55.6 nmol/L) were statistically lower than in healthy controls (71.8 nmol/L)
• Serum 25(OH)D levels in severe/critical COVID-19 cases (38.2 nmol/L) were significantly lower than that in mild/moderate cases (56.6 nmol/L)

Kaufman et al., 2020

• The SARS-CoV-2 positivity rate was lower in the 27,870 patients with “adequate” 25(OH)D values (30-34 ng/mL) (8.1%), than in the 39,190 patients with “deficiency” （<20 ng/mL) (12.5%) (difference 35%; p<0.001).
• Similarly, SARS-CoV-2 positivity rate was lower in the 12,321 patients with 25(OH)D values >=55 ng/mL (5.9%) than in patients with adequate values (difference 27%; p<0.001)

D'avolio et al., 2020

• Observed statistically significant (p = 0.004) lower 25(OH)D levels (11.1 ng/mL) in patients positive for the SARS-CoV-2 PCR compared with the negative patients (24.6 ng/mL)

Baktash et al., 2020

• Vitamin D levels in the COVID-19-positive group were overall significantly lower compared with that in the COVID-19-negative group (27.00 nmol/L vs 52.00 nmol/L) (p=0.0008)

Many clinical trials are underway which are testing Vitamin D to fight COVID-19