Serum Vitamin D levels are associated with increased COVID-19 severity and mortality independent of whole-body and visceral adiposity

Abstract

INTRODUCTION: Coronavirus disease (COVID-19) is a global pandemic. Vitamin D (25-OHD) deficiency has been associated with susceptibility to infectious disease. In this study, the association between COVID-19 outcomes and 25-OHD levels in patients attending a COVID-19 reference center in Mexico City are examined. METHODS: Consecutive patients with confirmed COVID-19 were evaluated. All patients underwent clinical evaluation (including outcomes), laboratory measurements (including 25-OHD) and a thoracic computerized tomography (including the measurement of epicardial fat thickness). Low vitamin D was defined as levels <20ng/mL (<50nmol/L) and severely low (or deficient) 25-OHD as a level ≤12ng/mL (<30nmol/L) RESULTS: Of the 551 patients included, low 25-OHD levels were present in 45.6% and severely low levels in 10.9%. Severely low 25-OHD levels were associated with mortality (HR 2.11, 95%CI 1.24-3.58, p=0.006) but not with critical COVID-19 (OR 0.97, 95%CI 0.94-0.99, p=0.042), adjusted for age, sex, body-mass index and epicardial fat. Using model-based causal mediation analyses the increased risk of COVID-19 mortality conferred by 25-OHD levels was partly mediated by its effect on D-dimer and cardiac ultrasensitive troponins. Notably, increased risk of COVID-19 mortality conferred by low vitamin D levels was independent of BMI and epicardial fat. CONCLUSION: Vitamin D deficiency (≤12ng/mL or <30nmol/L), is independently associated with COVID-19 mortality after adjustment for visceral fat (epicardial fat thickness). Low 25-OHD may contribute to a pro-inflammatory and pro-thrombotic state, increasing the risk for adverse COVID-19 outcomes.

Vitamin D deficiency is Associated with Increased Risk of Delirium and Mortality among Critically Ill, Elderly Covid-19 Patients

“…In the current study, vitamin D deficiency (<20 ng/mL) was associated with a higher risk of mortality among critically ill elderly COVID-19 patients. In line with our findings, a prospective study on 551 COVID-19 patients showed that vitamin D deficiency (≤12 ng/ml or <30 nmol/L) was significantly associated with COVID-19 mortality after controlling for visceral fat (epicardial fat thickness) 39 . In a retrospective study on 257 COVID-19 patients, Jenei et al reported that vitamin D deficiency is a potential risk factor for mortality among elderly COVID-19 patients with comorbidities (cancer, diabetes and/or pulmonary disease) 40 .…”

Vitamin D Status and SARS-CoV-2 Infection and COVID-19 Clinical Outcomes

“…Jan, January; Fe, February; Mar, March; Apr, April; Jun, June; Jul, July; 25OHD <25, 25OHD levels <25 nmol/L; 25OHD <50, 25OHD levels <50 nmol/L; 25OHD <75, 25OHD levels <75 nmol/L. The studies by Mendy et al ( 37 ) by Vanegas-Cedillo et al ( 84 ) by Vashegani et al ( 98 ) and by Walk ( 86 ) are in preprint form .…”

“…The quality of included studies varied consistently, with a NOS between 3 and 9 (median score 6). The 25OHD levels have been determined: (i) before SARS-CoV-2 test in 5 studies ( 45 , 50 , 51 , 56 , 59 ) and at SARS-CoV-2 test in 12 studies ( 46 – 49 , 52 – 55 , 57 , 58 , 60 , 61 ), (ii) before COVID-19 diagnosis in 3 studies ( 63 , 64 , 66 ) and at COVID-19 diagnosis in 6 studies, ( 49 , 57 , 60 , 62 , 65 , 67 ), and (iii) before COVID-19 related hospitalization in 7 studies ( 63 , 64 , 66 , 74 , 80 , 83 , 93 ), and at COVID-19 related hospitalization in 35 studies ( 49 , 52 , 55 , 57 , 58 , 61 , 65 , 67 – 73 , 75 – 79 , 81 , 82 , 84 – 92 , 94 – 98 ).…”

COVID-19 mortality risk correlates inversely with vitamin D3 status, and a mortality rate close to zero could theoretically be achieved at 50 ng/ml 25(OH)D3: Results of a systematic review and meta-analysis

“…A rapidly increasing number of publications are investigating the vitamin D3 status of SARS CoV 2 -patients and have confirmed both low vitamin D levels in cases of severe courses of infection [106][107][108][109][110][111][112][113][114][115][116][117][118][119][120][121] and positive results of vitamin D3 treatments [122][123][124][125][126][127][128]. Therefore, many scientists recommend vitamin D3 as an indispensable part of a medical treatment plan to avoid severe courses of SARS CoV 2 infection --…”