Low Vitamin D May Worsen COVID-19

Luigi Gennari, M.D., Ph.D., of the University of Siena in Italy

Improving vitamin D status might decrease the risk of developing severe respiratory distress and death in COVID-19 cases, shows an observational study presented September 11 at the American Society for Bone and Mineral Research (ASBMR) which was held virtually this week.

“Vitamin D deficiency is common in most countries, particularly during the winter season,” study author Luigi Gennari, M.D., Ph.D., of the University of Siena in Italy, told Rheumatology Network. “Vitamin D supplementation and the correction of vitamin D deficiency might be of major relevance for the reduction of the clinical burden of the ongoing and future outbreaks of SARS-CoV-2 infection.”

There is an ongoing debate on whether vitamin D deficiency leads to a poorer outcome in patients with COVID-19. Epidemiology data suggest a link between COVID-19 severity and prevalence in areas of vitamin D deficiency.

In this study, Dr. Gennari and colleagues investigated the association between 25-hydroxyvitamin-D (25OHD) levels and COVID-19 severity and mortality.

Researchers prospectively examined 103 patients (mean age 66.1 years) admitted to the hospital for symptomatic COVID-19 and 52 people with mild symptoms who did not have respiratory dysfunction. Participants with COVID-19had their vitamin D levels compared with 206 age and sex matched controls that underwent 25OH D measurement as part of a routine health visit from January to March.

At hospital admission, 25OHD levels were lower in patients with symptomatic COVID-19 (mean, 18 ng/mL) than in those with mild symptoms (30.3 ng/mL) or controls (25.4 ng/mL; p<0.0001 for both comparisons) and were inversely associated with interleukin (IL)-6 levels (p=0.004).

After hospital admission, 54 patients with symptomatic COVID-19 were admitted to an intensive care unit (ICU) due to severe acute respiratory distress syndrome. These patients had lower 25OHD (14.4 ng/mL) than patients with symptomatic COVID-19 not requiring ICU admission (22.4 ng/mL, p=0.0001) and higher IL-6 levels (49.6 versus 28.8 pg/mL, p=0.016, respectively).

Nineteen hospitalized patients died due to acute respiratory distress syndrome after an average of 19 days. The deceased patients had lower 25OHD (13.2 ng/mL) compared with those with COVID-19 who survived (19.3 ng/mL, p=0.03) and higher IL-6 levels (61.0 versus 34.9 pg/mL, p=0.02, respectively).

“Interestingly, 25OHD levels were inversely associated with either acute respiratory distress syndrome requiring ICU admission or mortality, regardless of IL-6 levels and the presence of major comorbidities,” the authors wrote. “Our data give a strong observational support to previous suggestions that reduced vitamin D levels may favor the appearance of severe respiratory dysfunction and increase the mortality risk in patients affected with COVID-19.”

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REFERENCE

[1023] Vitamin D Deficiency Is Independently Associated with COVID-19 Severity and Mortality. Luigi Gennari. September 11. ASMBR 2020 Annual Meeting Virtual Event.