ASSOCIATIONS OF VITAMIN D STATUS WITH SEVERITY OF ILLNESS AND MORTALITY IN COVID-19 PATIENTS ADMITTED AT ST. LUKE’S MEDICAL CENTER QUEZON CITY, APRIL TO SEPTEMBER 2020

Authors: R. R. Reyes, D. C. D. S. Redondo-Samin, P. F. Quilala, C. F. C. De Vera

Publisher: Clinical Nutrition Espen

Publication Date: NOVEMBER, 2021

URL: https://doi.org/10.1016/j.clnesp.2021.09.279

ABSTRACT:
Rationale: This study aims to determine whether baseline vitamin D status in newly admitted COVID-19 patients is associated with a severe disease course and mortality.
Methods: This retrospective study included newly admitted RT-PCR confirmed COVID-19 adult patients with baseline serum vitamin D (VitD) levels from April to September 2020. Suboptimal VitD was defined by 25-hydroxy vitamin D levels based on current guidelines as: VitD insufficiency is equal to or more than 20ng/ml to 30ng/ml and VitD deficiency is less than 20ng/ml with a severely deficient subgroup defined as less than 12ng/ml. Classification of COVID-19 infection was based on CDC criteria and severe disease course were those that belong to the severe and critical categories of COVID-19 classification or those who had any need for respiratory support and/or critical care treatment at any point from admission to discharge. Mortality is based on designated disposition of death from any cause upon discharge. Severe disease course and disposition of death upon discharge were defined in each VitD status group. Data analysis was applied to measure associations of baseline VitD status in COVID-19 patients with outcomes – severe disease course and death.
Results: A total of 192 newly admitted COVID-19 patients (mean [SD]age,61.33[16.22] years; 101[52.6%] men, 91[47.4%] women; and 106 [55.2%] 65 years and above had baseline VitD level measured upon admission. VitD status of the patients was categorized as sufficient - 39 patients (20.31%), insufficient - 81 patients (42.19%) and deficient - 72 patients (37.5%) with a severely deficient subgroup - 11 patients (5.73%). Overall, majority of patients – 79.69% had suboptimal VitD levels of less than 30ng/ml. When each VitD status group was considered, the VitD deficient group had the greatest number of patients that had a severe disease course at 69.44% and even a higher rate of 81.82% in the severely deficient subgroup. Similarly, most of the patients (80%) with death as outcome did not have VitD levels within the normal range, where 40% of those who died were VitD insufficient and 40% were VitD deficient. When each VitD status was considered, highest rate of death was seen in the VitD deficient group at 22.22% with a higher rate of 36.36% noted in the severely deficient subgroup. When both outcomes were considered, the highest rate of mortality among those that had a severe disease course was in the severely deficient subgroup at 44%. Overall calculations regarding the associations of being not sufficient in baseline vitamin D levels with a severe disease course (P=0.830) and mortality (P=0.956) in newly admitted COVID-19 patients did not reach statistical significance when compared to the vitamin D sufficient group. However, when each VitD status group was analyzed, an increasing gradient was noted with a strongest correlation seen in the severely deficient subgroup and both outcomes – severe disease course (insufficient P=0.714; deficient P=0.562; severely deficient P=0.210) and death (insufficient P=1.00; deficient P=0.785; severely deficient P=0.690).
Conclusion: In this single-center, retrospective study, baseline VitD insufficient status and VitD deficient status were not associated with increased risk for a severe COVID-19 disease course and death. Findings of suboptimal baseline VitD levels in the majority of patients suggests, that rational VitD supplementation in COVID-19 patients to achieve normal levels may be beneficial given its general safety and cost. Randomized trials and a larger population size are recommended to further elucidate the potential associations of VitD levels and COVID-19 outcomes observed in this study.
Disclosure of Interest: None Declared