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

Abstract

Objective Studies have demonstrated a potential correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This retrospective study examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2. Participants 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 (COVID-19) were searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test. Design Patients admitted to GMC with COVID-19 were categorized according to disease severity and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity was ascertained utilizing a multivariable regression analysis. To isolate the possible influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a cosinor model was used. Results Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection. A lower vitamin D status was more common in patients with the severe or critical disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 ng/mL [34.3%] p < 0.001). Patients with vitamin D deficiency (<20 ng/mL) were 14 times more likely to have severe or critical disease than patients with 25(OH)D ≥40 ng/mL (odds ratio [OR], 14; 95% confidence interval [CI], 4 to 51; p < 0.001). Conclusions Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.

The Role of Vitamin D in SARS-CoV-2 Infection and Acute Kidney Injury

“…The benefit of vitamin D supplements in preventing acute respiratory tract infections was observed via a meta-analysis of 11,321 participants and other reviews [23][24][25][26][27]. The possibility of decreasing the risk of respiratory tract infections, including coronavirus disease 2019 (COVID-19), may contribute to several immune pathways, such as stimulating antiviral mechanisms, reducing proinflammatory cytokines, modulating concentrations of ACE2, and decreasing the chances of endothelial dysfunction [28].…”

A strong association between the VDR gene markers and SARS-CoV-2 variants

“…Furthermore, it was discovered that VDR polymorphisms are independently related to the severity of COVID-19 and patient survival (Apaydin et al, 2022). In addition, recent Israeli research based on the rst two pandemic waves, which was prior to vaccine usage, discovered a risk of having severe COVID-19 in vitamin D de cient individuals (Dror et al, 2022). This case-control study is one of the few studies evaluating the association between SARS-CoV-2 variants of concern and VDR gene variations.…”

Low Serum Vitamin D in COVID-19 Patients Is Not Related to Inflammatory Markers and Patients’ Outcomes—A Single-Center Experience and a Brief Review of the Literature

“…The reduction in the vitamin D levels with age and the seasonal variation, with the lowest values during the cold season, seems to be in relation to higher case-fatality rates in older patients [ 15 ] and similarly with an increased seasonal incidence of the viral pathology. In a recent study, Dror et al found that hypovitaminosis D before SARS-CoV-2 infection was associated with more severe/critical illness, compared to patients with moderate/mild form, and the mortality rate was higher among patients with vitamin D insufficiency [ 38 ]. Similar to the previously mentioned study, we found that vitamin D deficiency is prevalent in moderate/severe disease forms and advanced age, compared to mild disease forms and younger subjects.…”