Akbar Mohammad Rizki, Wibowo Arief, Pranata Raymond, Setiabudiawan Budi
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Front Nutr. 2021 Mar 29;8:660420. doi: 10.3389/fnut.2021.660420. eCollection 2021.
This systematic review and meta-analysis aimed to assess whether low serum 25-hydroxyvitamin D (25-OHD) level is associated with susceptibility to COVID-19, severity, and mortality related to COVID-19. Systematic literature searches of PubMed, Scopus, and Embase database up until 9 December 2020. We include published observational prospective and retrospective studies with information on 25-OHD that reported main/secondary outcome. Low serum 25-OHD refers to participants with serum 25-OHD level below a cut-off point ranging from 20 to 30 ng/mL. Other cut-off values were excluded to reduce heterogeneity. The main outcome was mortality defined as non-survivor/death. The secondary outcome was susceptibility and severe COVID-19. There were 14 studies comprising of 999,179 participants. Low serum 25-OHD was associated with higher rate of COVID-19 infection compared to the control group (OR = 2.71 [1.72, 4.29], < 0.001; : 92.6%). Higher rate of severe COVID-19 was observed in patients with low serum 25-OHD (OR = 1.90 [1.24, 2.93], = 0.003; : 55.3%), with a sensitivity of 83%, specificity of 39%, PLR of 1.4, NLR of 0.43, and DOR of 3. Low serum 25-OHD was associated with higher mortality (OR = 3.08 [1.35, 7.00], = 0.011; : 80.3%), with a sensitivity of 85%, specificity of 35%, PLR of 1.3, NLR of 0.44, and DOR of 3. Meta-regression analysis showed that the association between low serum 25-OHD and mortality was affected by male gender (OR = 1.22 [1.08, 1.39], = 0.002), diabetes (OR = 0.88 [0.79, 0.98], = 0.019). Low serum 25-OHD level was associated with COVID-19 infection, severe presentation, and mortality.
本系统评价和荟萃分析旨在评估低血清25-羟基维生素D（25-OHD）水平是否与COVID-19易感性、严重程度及相关死亡率有关。截至2020年12月9日，对PubMed、Scopus和Embase数据库进行系统文献检索。我们纳入已发表的观察性前瞻性和回顾性研究，这些研究包含25-OHD信息并报告了主要/次要结局。低血清25-OHD指血清25-OHD水平低于20至30 ng/mL切点值的参与者。排除其他切点值以减少异质性。主要结局为死亡率，定义为非幸存者/死亡。次要结局为易感性和重症COVID-19。共有14项研究，涉及999,179名参与者。与对照组相比，低血清25-OHD与更高的COVID-19感染率相关（比值比[OR]=2.71[1.72,4.29]，P<0.001；I²：92.6%）。低血清25-OHD患者中观察到更高的重症COVID-19发生率（OR=1.90[1.24,2.93]，P=0.003；I²：55.3%），敏感性为83%，特异性为39%，阳性似然比为1.4，阴性似然比为0.43，诊断比值比为3。低血清25-OHD与更高的死亡率相关（OR=3.08[1.35,7.00]，P=0.011；I²：80.3%）），敏感性为85%，特异性为35%，阳性似然比为1.3，阴性似然比为0.44，诊断比值比为3。Meta回归分析显示，低血清25-OHD与死亡率之间的关联受男性性别（OR=1.22[1.08,1.39]，P=0.002）、糖尿病（OR=0.88[0.79,0.98]，P=0.019）影响。低血清25-OHD水平与COVID-19感染、严重表现及死亡率有关。
