COVID-19 death in hospital 5X more likely if low vs high vitamin D – preprint June 2021

Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness

doi: https://doi.org/10.1101/2021.06.04.21258358
Amiel A. Dror, Nicole G. Morozov, Amani Daoud, Yoav Namir, Yakir Orly, Yair Shachar, Mark Lifshitz, Ella Segal, Lior Fischer, Matti Mizrachi, Netanel Eisenbach, Doaa Rayan, Maayan Gruber, Amir Bashkin, Edward Kaykov, Masad Barhoum, Michael Edelstein, Eyal Sela

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<20 ng vs >40 ng in Galilee Hospital in Israel April 2020 to Feb 2021
Vitamin D data from blook taken 2 to 104 weeks before positive PCR test

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Objective Studies have demonstrated a potential link between low vitamin D levels and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes but have not established temporality. This retrospective study examined if, and to what degree, a relationship exists between pre-infection serum vitamin D levels and disease severity and mortality of SARS-CoV-19.

Design and patients The records of individuals admitted between April 7th, 2020 and February 4th, 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 were searched for vitamin D (VitD) levels measured 14 to 730 days prior to the positive PCR test.

Measurements Patients admitted to GMC with COVID-19 were categorized according to disease severity and VitD level. Association between pre-infection VitD levels and COVID-19 severity was ascertained utilizing a multivariate regression analysis.

Results Of 1176 patients admitted, 253 had VitD levels prior to COVID-19 infection. Compared with mildly or moderately diseased patients, those with severe or critical COVID-19 disease were more likely to have pre-infection vitamin D deficiency of less than 20 ng/mL (OR=14.30, 95%, 4.01-50.9; p < .001); be older (OR=1.039 for each year, 95% CI for OR, 1.017-1.061; p< .01), and have diabetes (OR=2.031, 95% CI for OR, 1.04-3.36; p= 0.038). Vitamin D deficiency was associated with higher rates of mortality (p<0.001) and comorbidities including COPD (p=0.006), diabetes (p=0.026), and hypertension (p=0.016).

Conclusions Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.
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