Vitamin D status and outcomes for hospitalised older patients with COVID-19

Postgrad Med J. 2021 Jul;97(1149):442-447. doi: 10.1136/postgradmedj-2020-138712. Epub 2020 Aug 27.

Abstract

Purpose: Older adults are more likely to be vitamin D deficient. The aim of the study was to determine whether these patients have worse outcomes with COVID-19.

Methods: We conducted a prospective cohort study between 1 March and 30 April 2020 to assess the importance of vitamin D deficiency in older patients with COVID-19. The cohort consisted of patients aged ≥65 years presenting with symptoms consistent with COVID-19 (n=105). All patients were tested for serum 25-hydroxyvitamin D (25(OH)D) levels during acute illness. Diagnosis of COVID-19 was confirmed via viral reverse transcriptase PCR swab or supporting radiological evidence. COVID-19-positive arm (n=70) was sub-divided into vitamin D-deficient (≤30 nmol/L) (n=39) and -replete groups (n=35). Subgroups were assessed for disease severity using biochemical, radiological and clinical markers. Primary outcome was in-hospital mortality. Secondary outcomes were laboratory features of cytokine storm, thoracic imaging changes and requirement of non-invasive ventilation (NIV).

Results: COVID-19-positive arm demonstrated lower median serum 25(OH)D level of 27 nmol/L (IQR=20-47 nmol/L) compared with COVID-19-negative arm, with median level of 52 nmol/L (IQR=31.5-71.5 nmol/L) (p value=0.0008). Among patients with vitamin D deficiency, there was higher peak D-dimer level (1914.00 μgFEU/L vs 1268.00 μgFEU/L) (p=0.034) and higher incidence of NIV support and high dependency unit admission (30.77% vs 9.68%) (p=0.042). No increased mortality was observed between groups.

Conclusion: Older adults with vitamin D deficiency and COVID-19 may demonstrate worse morbidity outcomes. Vitamin D status may be a useful prognosticator.

Keywords: General medicine (see internal medicine); calcium & bone; diabetes & endocrinology; geriatric medicine.

MeSH terms

  • Aged
  • Biomarkers / blood
  • COVID-19* / blood
  • COVID-19* / mortality
  • COVID-19* / physiopathology
  • COVID-19* / therapy
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Geriatric Assessment / methods
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Pneumonia, Viral* / diagnostic imaging
  • Pneumonia, Viral* / etiology
  • Predictive Value of Tests
  • Radiography, Thoracic / statistics & numerical data
  • SARS-CoV-2 / isolation & purification
  • Severity of Illness Index
  • United Kingdom / epidemiology
  • Vitamin D / analogs & derivatives*
  • Vitamin D / blood
  • Vitamin D Deficiency* / blood
  • Vitamin D Deficiency* / epidemiology
  • Vitamin D Deficiency* / therapy

Substances

  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Vitamin D
  • 25-hydroxyvitamin D