American Society for Bone and Mineral Research (Virtual)
American Society for Bone and Mineral Research (Virtual)
Source/Disclosures
Source:

Gennari L, et al. Vitamin D deficiency is independently associated with COVID-19 severity and mortality. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 11-15, 2020 (virtual meeting).

Disclosures: Gennari reports no relevant financial disclosures.
September 11, 2020
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Low vitamin D levels independently associated with severe COVID-19 cases, death

Source/Disclosures
Source:

Gennari L, et al. Vitamin D deficiency is independently associated with COVID-19 severity and mortality. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 11-15, 2020 (virtual meeting).

Disclosures: Gennari reports no relevant financial disclosures.
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Adults with vitamin D deficiency are at greater risk for severe COVID-19 infection and death, according to data presented at the American Society for Bone and Mineral Research virtual meeting.

Luigi Gennari

“Vitamin D deficiency is common in most countries, particularly during the winter season,” Luigi Gennari, MD, PhD, associate professor in the department of medicine, surgery and neurosciences at the University of Siena, Italy, told Healio. “Improving vitamin D status might decrease the risk of developing severe respiratory distress associated with the SARS-CoV-2 infection.”

Vitamin D levels were lower for adults hospitalized with COVID-19 compared with those who had a mild case.

Gennari and colleagues analyzed data from 103 adults (mean age, 66.1 years) admitted to San Luca Hospital in Milan, Italy, with COVID-19 symptoms; and 52 residents and employees of an Italian nursing home with mild symptoms who did not have respiratory dysfunction. Those with COVID-19 had 25-hydroxyvitamin D levels compared with 206 age- and sex-matched adults who had levels measured as part of a routine health visit from January to March.

The hospitalized COVID-19 group had lower 25-(OH)D levels (mean, 18.2 ng/mL) than the group with mild symptoms (30.3 ng/mL) or the control group (25.4 ng/mL; P < .0001 for both).

Of the hospitalized group, 54 patients were admitted to the ICU with severe acute respiratory distress syndrome. When compared with patients who were hospitalized without ICU admission, those admitted to the ICU had lower 25-(OH)D levels (mean, 14.4 ng/mL vs. 22.4 ng/mL; P = .0001) and higher interleukin-6 levels (mean, 49.6 pg/mL vs. 28.8 pg/mL; P = .016). Having a low 25-(OH)D level was associated with higher odds of ICU admission (OR = 1.06; 95% CI, 1.01-1.12).

Nineteen hospitalized patients died due to acute respiratory distress syndrome caused by COVID-19. Compared with COVID-19 cases who survived, those who died had lower 25-(OH)D levels (mean, 13.2 ng/mL vs. 19.3 ng/mL; P = .03) and higher IL-6 levels (mean, 61 pg/mL vs. 34.9 pg/mL; P = .02). As with the ICU group, having a low 25-(OH)D level was associated with a higher mortality risk from COVID-19 (OR = 1.18; 95% CI, 1.02-1.37).

The associations between vitamin D levels and COVID-19 ICU admission and death were independent of IL-6 levels and the presence of major comorbidities, according to the researchers.

“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,” Gennari said.

Gennari noted that other factors, such as location and demographics, also suggest an association between low vitamin D levels and higher chances of COVID-19 severity and mortality.

“The highest mortality rates of COVID-19 have been generally reported in countries with lower average levels of vitamin D or above the [37th parallel north] geographic latitude line, where the solar ultraviolet-B radiation exposure does not allow the skin to synthesize vitamin D in the winter season,” Gennari said. “Demographic groups known to be at higher risk of vitamin D deficiency — eg, Black individuals, older people, nursing-home residents, and those with obesity or diabetes — are at high risk of COVID-19 hospitalization and mortality.”

Gennari said intervention trials are needed to explore whether vitamin D supplementation could prevent respiratory failure in people with COVID-19 or other serious respiratory infections.