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Vitamin D, vitamin D-binding protein, free vitamin D and COVID-19 mortality in hospitalized patients.
Subramanian, Sreedhar; Rhodes, Jonathan M; Taylor, Joseph M; Milan, Anna M; Lane, Steven; Hewison, Martin; Chun, Rene F; Jorgensen, Andrea; Richardson, Paul; Nitchingham, Darshan; Aslan, Joseph; Shah, Maya; Chandrasekar, Coonoor R; Wood, Amanda; Beadsworth, Mike; Pirmohamed, Munir.
  • Subramanian S; Department of Gastroenterology, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Rhodes JM; Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
  • Taylor JM; Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
  • Milan AM; Department of Clinical Chemistry, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Lane S; Department of Clinical Chemistry, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Hewison M; Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
  • Chun RF; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.
  • Jorgensen A; Department of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
  • Richardson P; Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom.
  • Nitchingham D; Department of Gastroenterology, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Aslan J; Department of Gastroenterology, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Shah M; Department of Gastroenterology, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Chandrasekar CR; Department of Gastroenterology, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Wood A; Department of Orthopaedic Surgery, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Beadsworth M; Department of Clinical Pharmacology, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
  • Pirmohamed M; Tropical and Infectious Diseases Unit, Liverpool University Hospital Foundation NHS Trust, Liverpool, United Kingdom.
Am J Clin Nutr ; 115(5): 1367-1377, 2022 05 01.
Article in English | MEDLINE | ID: covidwho-1662101
ABSTRACT

BACKGROUND:

Vitamin D deficiency has been associated with worse coronavirus disease 2019 (COVID-19) outcomes, but circulating 25-hydroxyvitamin D [25(OH)D] is largely bound to vitamin D-binding protein (DBP) or albumin, both of which tend to fall in illness, making the 25(OH)D status hard to interpret. Because of this, measurements of unbound ("free") and albumin-bound ("bioavailable") 25(OH)D have been proposed.

OBJECTIVES:

We aimed to examine the relationship between vitamin D status and mortality from COVID-19.

METHODS:

In this observational study conducted in Liverpool, UK, hospitalized COVID-19 patients with surplus sera available for 25(OH)D analysis were studied. Clinical data, including age, ethnicity, and comorbidities, were extracted from case notes. Serum 25(OH)D, DBP, and albumin concentrations were measured. Free and bioavailable 25(OH)D were calculated. Relationships between total, free, and bioavailable 25(OH)D and 28-day mortality were analyzed by logistic regression.

RESULTS:

There were 472 patients with COVID-19 included, of whom 112 (23.7%) died within 28 days. Nonsurvivors were older (mean age, 73 years; range, 34-98 years) than survivors (mean age, 65 years; range, 19-95 years; P = 0.003) and were more likely to be male (67%; P = 0.02). The frequency of vitamin D deficiency [25(OH)D < 50 nmol/L] was similar between nonsurvivors (71/112; 63.4%) and survivors (204/360; 56.7%; P = 0.15) but, after adjustments for age, sex, and comorbidities, increased odds for mortality were present in those with severe deficiency [25(OH)D < 25 nmol/L OR, 2.37; 95% CI, 1.17-4.78] or a high 25(OH)D (≥100 nmol/L; OR, 4.65; 95% CI, 1.51-14.34) compared with a 25(OH)D value of 50-74 nmol/L (reference). Serum DBP levels were not associated with mortality after adjustments for 25(OH)D, age, sex, and comorbidities. Neither free nor bioavailable 25(OH)D values were associated with mortality.

CONCLUSIONS:

Vitamin D deficiency, as commonly defined by serum 25(OH)D levels (<50 nmol/L), is not associated with increased mortality from COVID-19, but extremely low (<25 nmol/L) and high (>100 nmol/L) levels may be associated with mortality risks. Neither free nor bioavailable 25(OH)D values are associated with mortality risk. The study protocol was approved by the London-Surrey Research Ethics Committee (20/HRA/2282).
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vitamin D Deficiency / COVID-19 Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: Am J Clin Nutr Year: 2022 Document Type: Article Affiliation country: Ajcn

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vitamin D Deficiency / COVID-19 Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: Am J Clin Nutr Year: 2022 Document Type: Article Affiliation country: Ajcn