Low vitamin D levels predict outcomes of COVID-19 in patients with both severe and non-severe disease at hospitalization

• Published in: Endocrine Vol. 80; no. 3; pp. 669 - 683
• Main Authors: di Filippo, Luigi, Uygur, Melin, Locatelli, Massimo, Nannipieri, Fabrizio, Frara, Stefano, Giustina, Andrea
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2023; Springer Nature B.V
• Subjects: Comorbidity; Coronaviruses; COVID-19; Diabetes; Endocrinology; Hospitalization; Humanities and Social Sciences; Humans; Internal Medicine; Medicine; Medicine & Public Health; multidisciplinary; Original; Original Article; Outpatients; Retrospective Studies; Risk factors; Science; Vitamin D; Vitamin D Deficiency - complications; Vitamin D Deficiency - epidemiology; Vitamin deficiency; Vitamins; COVID-19; SARS-CoV-2; ACE-2; Vitamin D; Hypovitaminosis D
• ISSN: 1559-0100; 1355-008X; 1559-0100
• DOI: 10.1007/s12020-023-03331-9

Purpose Low vitamin D in COVID-19 have been related to worse outcomes. However, most of the studies conducted so far were not-controlled and retrospective, including biases potentially influencing this association. We evaluated 25(OH)vitamin D levels of patients with both severe and non-severe disease at hospital-admission, and in a cohort of control subjects. Moreover, we evaluated sACE-2 levels to investigate the mechanisms underlying the association between vitamin D and COVID-19. Methods COVID-19 patients were enrolled in a matched for age, sex and comorbidities 1:1-ratio based on the presence/or not of respiratory-distress/severe-disease at hospital-admission. Control matched subjects were enrolled from an outpatient-setting. Results Seventy-three COVID-19 patients (36 severe and 37 non-severe) and 30 control subjects were included. We observed a higher vitamin D deficiency (<20 ng/mL) prevalence in COVID-19 patients than control subjects (75% vs 43%). No differences were found regarding 25(OH)vitamin D and sACE-2 levels between patients with and without severe-disease at study entry. During the disease-course, in the severe group a life-threatening disease occurred in 17 patients (47.2%), and, in the non-severe group, a worsening disease occurred in 10 (27%). 25(OH)vitamin D levels, at admission, were negatively correlated with sACE-2 levels, and were lower in patients whose disease worsened as compared to those in whom it did not, independently from the disease severity at admission. In multivariate-analysis, lower 25(OH)vitamin D resulted as an independent risk factor for disease worsening. Conclusions 25(OH)vitamin D levels at hospital-admission strongly predicted the occurrence of worsening outcomes in COVID-19 independently of the disease severity at presentation.