Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness
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Abstract
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 7 th , 2020 and February 4 th , 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.
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SciScore for 10.1101/2021.06.04.21258358: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Prior to study initiation, ethical approval was granted by the Research Ethics Committee of the Galilee Medical Center 0204-20-NHR. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The analysis was performed using the IBM SPSS Statistic software, version 27.0. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The…
SciScore for 10.1101/2021.06.04.21258358: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Prior to study initiation, ethical approval was granted by the Research Ethics Committee of the Galilee Medical Center 0204-20-NHR. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources The analysis was performed using the IBM SPSS Statistic software, version 27.0. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:There are several important limitations of the study. First, vitamin D deficiency can be a part of a wide range of chronic health conditions or behavioral factors that simultaneously increase COVID-19 disease severity and mortality risks. As an example, COPD, while associated with VDD in our study, is a known risk factor for poorer COVID-19 outcomes. It should be clearly stated that a patient’s historically low VitD levels do not cause COVID-19 but rather may increase the likelihood of SARS-COV-2 infection and morbidity and mortality under various clinical settings 23–25. Moreover, VitD correction in the community setting preceding the infection will not necessarily improve the future COVID-19 disease course of an affected individual. Patients’ supplementation history was not obtained or analyzed as part of this research. The use of historical results from community health providers may be influenced by prior VDD correction therapy given due to low serum levels, the effect of which is difficult to fully deduce. However, our cohort’s strong correlation between prior VDD and COVID-19 disease outcome implies that most patients remain with low VitD levels when contracting COVID-19 infection. Third, despite our findings, it must be acknowledged recent study in India found no association between VDD and increased mortality and morbidity in hospitalized patients 26. In this prospective study in which patients’ VitD levels were measured during hospitalization, the patients had a medi...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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