tetano
Editor, Senior Moderator
Am J Clin Nutr
. 2022 Jan 31;nqac027.
doi: 10.1093/ajcn/nqac027. Online ahead of print.
Vitamin D, D-binding protein, free vitamin D and COVID-19 mortality in hospitalized patients
Sreedhar Subramanian[SUP] 1 2 [/SUP], Jonathan M Rhodes[SUP] 2 [/SUP], Joseph M Taylor[SUP] 3 [/SUP], Anna M Milan[SUP] 3 [/SUP], Steven Lane[SUP] 4 [/SUP], Martin Hewison[SUP] 5 [/SUP], Rene F Chun[SUP] 6 [/SUP], Andrea Jorgensen[SUP] 7 [/SUP], Paul Richardson[SUP] 1 [/SUP], Darshan Nitchingham[SUP] 1 [/SUP], Joseph Aslan[SUP] 1 [/SUP], Maya Shah[SUP] 1 [/SUP], Coonoor R Chandrasekar[SUP] 8 [/SUP], Amanda Wood[SUP] 9 [/SUP], Mike Beadsworth[SUP] 10 [/SUP], Munir Pirmohamed[SUP] 11 [/SUP]
Affiliations
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 25(OH)D status hard to interpret. Because of this, measurement of unbound "free" and albumin-bound "bioavailable" 25(OH) D has been proposed.
Objective: 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 co-morbidities 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.
Findings: Four hundred and seventy-two patients with COVID-19 were included, of whom 112 (23.7%) died within 28 days. Non-survivors were older (mean age 73, [range 34-98]) than survivors (65, [19-95]; P = 0.003) and more likely male (67%; P = 0.02). The frequency of vitamin D deficiency (25(OH)D <50nmol/L) was similar between non-survivors (71/112 [63.4%]) and survivors (204/360 [56.7%]; P = 0.15) but, after adjustment for age, sex and co-morbidities, increased odds for mortality were present in those with severe deficiency (25(OH)D <25nmol/L), OR 2.37 (95% CI 1.17, 4.78), or high 25(OH)D (≥100nmol/L), OR 4.65 (95% CI 1.51, 14.34) compared with 25(OH)D 50-74 nmol/L (reference). Serum DBP levels were not associated with mortality after adjustment for 25(OH)D, age, sex and co-morbidities. Neither free nor bioavailable 25(OH)D were associated with mortality.
Conclusion: : Vitamin D deficiency as commonly defined by serum 25 (OH)D levels (<50nmol/L) is not associated with increased mortality from COVID-19 but extreme low (<25nmol/L) and high (>100nmol/L) levels may be associated with risk. Neither free nor bioavailable 25(OH) D associate with risk.
Keywords: COVID-19 mortality; D-binding protein; Vitamin D; bioavailable vitamin D; free vitamin D.
. 2022 Jan 31;nqac027.
doi: 10.1093/ajcn/nqac027. Online ahead of print.
Vitamin D, D-binding protein, free vitamin D and COVID-19 mortality in hospitalized patients
Sreedhar Subramanian[SUP] 1 2 [/SUP], Jonathan M Rhodes[SUP] 2 [/SUP], Joseph M Taylor[SUP] 3 [/SUP], Anna M Milan[SUP] 3 [/SUP], Steven Lane[SUP] 4 [/SUP], Martin Hewison[SUP] 5 [/SUP], Rene F Chun[SUP] 6 [/SUP], Andrea Jorgensen[SUP] 7 [/SUP], Paul Richardson[SUP] 1 [/SUP], Darshan Nitchingham[SUP] 1 [/SUP], Joseph Aslan[SUP] 1 [/SUP], Maya Shah[SUP] 1 [/SUP], Coonoor R Chandrasekar[SUP] 8 [/SUP], Amanda Wood[SUP] 9 [/SUP], Mike Beadsworth[SUP] 10 [/SUP], Munir Pirmohamed[SUP] 11 [/SUP]
Affiliations
- PMID: 35102371
- DOI: 10.1093/ajcn/nqac027
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 25(OH)D status hard to interpret. Because of this, measurement of unbound "free" and albumin-bound "bioavailable" 25(OH) D has been proposed.
Objective: 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 co-morbidities 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.
Findings: Four hundred and seventy-two patients with COVID-19 were included, of whom 112 (23.7%) died within 28 days. Non-survivors were older (mean age 73, [range 34-98]) than survivors (65, [19-95]; P = 0.003) and more likely male (67%; P = 0.02). The frequency of vitamin D deficiency (25(OH)D <50nmol/L) was similar between non-survivors (71/112 [63.4%]) and survivors (204/360 [56.7%]; P = 0.15) but, after adjustment for age, sex and co-morbidities, increased odds for mortality were present in those with severe deficiency (25(OH)D <25nmol/L), OR 2.37 (95% CI 1.17, 4.78), or high 25(OH)D (≥100nmol/L), OR 4.65 (95% CI 1.51, 14.34) compared with 25(OH)D 50-74 nmol/L (reference). Serum DBP levels were not associated with mortality after adjustment for 25(OH)D, age, sex and co-morbidities. Neither free nor bioavailable 25(OH)D were associated with mortality.
Conclusion: : Vitamin D deficiency as commonly defined by serum 25 (OH)D levels (<50nmol/L) is not associated with increased mortality from COVID-19 but extreme low (<25nmol/L) and high (>100nmol/L) levels may be associated with risk. Neither free nor bioavailable 25(OH) D associate with risk.
Keywords: COVID-19 mortality; D-binding protein; Vitamin D; bioavailable vitamin D; free vitamin D.
