Sex-specific association between vitamin D deficiency and COVID-19 mortality in older patients

Hars, Mélany; Mendes, Aline; Serratrice, J.; Herrmann, Françoís; Gold, Gabriel; Graf, Christophe; Zekry, Dina; Trombetti, Andrea

doi:10.1007/s00198-020-05677-6

Cited by 19 publications

(30 citation statements)

References 4 publications

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“…Indeed, vitamin D may cooperate with progesterone to regulate immunity (potentially by upregulating the VDR) to control pro-inflammatory cytokine expression ( 260 ). Of importance here were recent findings that men (but not women) with vitamin D deficiency [25(OH)D < 50 nmol/L] were at increased “risk” of dying due to COVID-19 ( 210 ), with similar findings in a second study ( 208 ). Age may be another important factor to consider as a significant interaction between age and vitamin D deficiency was observed for associations with COVID-19 severity in one study ( 215 ).…”

Section: Vitamin D and Covid-19supporting

confidence: 58%

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Gorman

Weller

2020

Front. Cardiovasc. Med.

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During the COVID-19 (coronavirus disease of 2019) pandemic, researchers have been seeking low-cost and accessible means of providing protection from its harms, particularly for at-risk individuals such as those with cardiovascular disease, diabetes and obesity. One possible way is via safe sun exposure, and/or dietary supplementation with induced beneficial mediators (e.g., vitamin D). In this narrative review, we provide rationale and updated evidence on the potential benefits and harms of sun exposure and ultraviolet (UV) light that may impact COVID-19. We review recent studies that provide new evidence for any benefits (or otherwise) of UV light, sun exposure, and the induced mediators, vitamin D and nitric oxide, and their potential to modulate morbidity and mortality induced by infection with SARS-CoV-2 (severe acute respiratory disease coronavirus-2). We identified substantial interest in this research area, with many commentaries and reviews already published; however, most of these have focused on vitamin D, with less consideration of UV light (or sun exposure) or other mediators such as nitric oxide. Data collected to-date suggest that ambient levels of both UVA and UVB may be beneficial for reducing severity or mortality due to COVID-19, with some inconsistent findings. Currently unresolved are the nature of the associations between blood 25-hydroxyvitamin D and COVID-19 measures, with more prospective data needed that better consider lifestyle factors, such as physical activity and personal sun exposure levels. Another short-coming has been a lack of measurement of sun exposure, and its potential to influence COVID-19 outcomes. We also discuss possible mechanisms by which sun exposure, UV light and induced mediators could affect COVID-19 morbidity and mortality, by focusing on likely effects on viral pathogenesis, immunity and inflammation, and potential cardiometabolic protective mechanisms. Finally, we explore potential issues including the impacts of exposure to high dose UV radiation on COVID-19 and vaccination, and effective and safe doses for vitamin D supplementation.

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Section: Vitamin D and Covid-19supporting

confidence: 58%

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Gorman

Weller

2020

Front. Cardiovasc. Med.

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“…After reading the full text of these 112 studies, 101 were excluded for one or more of the following reasons: wrong study design, wrong study population, wrong outcome criterion, or overlapping data. Thus, 11 studies were included in the final review [17][18][19][20][21][22][23][24][25][26][27]. Because of the heterogeneity of outcomes between studies, a meta-analysis was not performed.…”

Section: Resultsmentioning

confidence: 99%

“…Because of the heterogeneity of outcomes between studies, a meta-analysis was not performed. Some authors agreed to provide data specific to the subpopulation of persons aged 60 years or older [19][20][21][22][23][24][25][26]. Concerning the study by Tan et al [27], the systematic review data were restricted to the subgroup of 60 years or older.…”

Section: Resultsmentioning

confidence: 99%

Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Dramé

Cofais²,

Hentzien

et al. 2021

Nutrients

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Background: Vitamin D has diverse and extensive effects on the immune system, including activating innate immunity and reducing the overactive adaptive immune response. A systematic review was performed to identify and synthesize the best available evidence on the association between vitamin D level and risk of COVID-19, adverse outcomes and possible benefits of supplementation in aged 60 years or over. Methods: A literature search was performed in PubMed© and Scopus© for all publications from inception published before 15 March 2021. Studies reporting data from aged patients on vitamin D use and COVID-19 were included. Basic science articles, editorials and correspondence were excluded. Publication year, study design and setting, characteristics of the study population were extracted. This study is registered with PROSPERO, under the number CRD42020223993. Results: In total, 707 studies were identified, of which 11 observational studies were included in the final review. Four studies compared vitamin D-supplemented COVID-19 patients to non-supplemented patients, and seven compared patients with vitamin D deficiency to patients without deficiency. In all four studies, patients with vitamin D supplementation had better rates of primary clinical outcomes (death, the severity of the disease, oxygen therapy requirement…). In studies comparing patients with vitamin D deficiency and patients without vitamin D deficiency, those without vitamin D deficiency had better primary clinical outcomes (death rate, the severity of the disease, oxygen therapy requirement, invasive mechanical ventilation need…). Conclusion: This systematic review seems to support an association between vitamin D deficiency and the risk of COVID-19 in aged people. In addition, vitamin D deficiency appears to expose these subjects to a greater risk of adverse outcomes. Because of its simplicity of administration, and the rarity of side effects, including vitamin D in preventive strategies for certain viral diseases, it appears to be an attractive option.

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“…Radujkovic et al ( 28 ) demonstrated in a retrospective cohort study of 185 patients that serum 25(OH)D level of <12 ng/mL was associated with higher risk of invasive mechanical ventilation (adjusted HR 6.12, 95% CI 2.79 – 13.42) and death (adjusted HR 14.73, 95% CI 4.16 – 52.19), after adjusting for age, sex and comorbidities. Hars et al( 29 ) used data of 160 elderly inpatients from the COVIDAge study and showed that vitamin D was independently associated with in-hospital mortality risk in men (adjusted HR 2.47, 95%CI 1.02 – 5.97) but not in women, after adjustment for age, comorbidities, C-reactive protein level, and frailty status). On the other hand, Hernández et al( 30 ) reported in a case–control study of 216 COVID-19 patients and 197 controls that although serum 25(OH)D levels was significantly lower in COVID-19 patients versus controls, the authors suggested that there was causal relationship between vitamin D deficiency and COVID-19 severity.…”

Section: Discussionmentioning

confidence: 99%

Association of Vitamin D Status With Hospital Morbidity and Mortality in Adult Hospitalized Patients With COVID-19

et al. 2021

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Objective To determine the association between vitamin D status and morbidity and mortality in adult hospitalized COVID-19 patients Methods We performed a retrospective chart review study in COVID-19 patients aged ≥18 years old hospitalized at Boston University Medical Center between March 1 – August 4, 2020. All studied patients were tested positive for COVID-19 and had serum levels of 25-hydroxyvitamin D results measured within one year prior to the date of positive tests. Medical information was retrieved from the electronic medical record and were analyzed to determine the association between vitamin D status and hospital morbidity and mortality. Results Among the 287 patients, 100 (36%) patients were vitamin D-sufficient [25(OH)D >30 ng/mL] and 41 (14%) patients died during the hospitalization. Multivariate analysis in patients aged ≥65 years old revealed that vitamin D sufficiency [25(OH)D ≥30 ng/mL] was statistically significantly associated with decreased odds of death (adjusted OR 0.33, 95%CI, 0.12–0.94), acute respiratory distress syndrome (adjusted OR 0.22, 95%CI, 0.05–0.96), and severe sepsis/septic shock (adjusted OR 0.26, 95%CI, 0.08–0.88), after adjustement for potential confounders. Among patients with body mass index <30 kg/m 2 , vitamin D sufficiency was statistically significantly associated with a decreased odds of death (adjusted OR 0.18, 95%CI, 0.04–0.84). No significant association was found in the subgroups of patients aged <65 years old or BMI ≥30 kg/m 2 . Conclusion We revealed an independent association between vitamin D sufficiency defined by serum 25(OH)D ≥30 ng/mL and decreased risk of mortality from COVID-19 in elderly patients and patients without obesity.

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Sex-specific association between vitamin D deficiency and COVID-19 mortality in older patients

Cited by 19 publications

References 4 publications

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

Relation between Vitamin D and COVID-19 in Aged People: A Systematic Review

Association of Vitamin D Status With Hospital Morbidity and Mortality in Adult Hospitalized Patients With COVID-19

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