Drug Safety Research Center, Facultad de Medicina Humana, Universidad de San Martín de Porres, Hospital Almenara, ESSALUD, Lima, Peru.
Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru.
Adv Respir Med. 2021;89(2):145-157. doi: 10.5603/ARM.a2021.0037.
There is increasing scientific interest in the possible association between hypovitaminosis D and the risk of SARS-CoV-2 infection severity and/or mortality.
To conduct a metanalysis of the association between 25-hydroxyvitamin D (25(OH)D) concentration and SARS-CoV-2 infection severity or mortality.
We searched PubMed, EMBASE, Google scholar and the Cochrane Database of Systematic Reviews for studies published between December 2019 and December 2020. Effect statistics were pooled using random effects models. The quality of included studies was assessed with the Newcastle-Ottawa Scale (NOS). Targeted outcomes: mortality and severity proportions in COVID-19 patients with 25(OH)D deficiency, defined as serum 25(OH)D < 50 nmol/L.
In the 23 studies included (n = 2692), the mean age was 60.8 (SD ± 15.9) years and 53.8% were men. Results suggested that vitamin 25(OH)D deficiency was associated with increased risk of severe SARS-CoV-2 disease (RR 2.00; 95% CI 1.47-2.71, 17 studies) and mortality (RR 2.45; 95% CI 1.24-4.84, 13 studies). Only 7/23 studies reported C-reactive protein values, all of which were > 10 mg/L. Conclusions 25(OH)D deficiency seems associated with increased SARS-CoV-2 infection severity and mortality. However, findings do not imply causality, and randomized controlled trials are required, and new studies should be designed to determine if decreased 25(OH)D is an epiphenomenon or consequence of the inflammatory process associated with severe forms of SARS-CoV-2. Meanwhile, the concentration of 25(OH)D could be considered as a negative acute phase reactant and a poor prognosis in COVID-19 infection.
人们对维生素 D 缺乏症与 SARS-CoV-2 感染严重程度和/或死亡率之间可能存在的关联越来越感兴趣。
对 25-羟维生素 D（25（OH）D）浓度与 SARS-CoV-2 感染严重程度或死亡率的关系进行荟萃分析。
我们检索了 2019 年 12 月至 2020 年 12 月期间发表的 PubMed、EMBASE、Google Scholar 和 Cochrane 系统评价数据库中的研究。使用随机效应模型对汇总的效应统计数据进行合并。使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。靶向结局：血清 25（OH）D<50nmol/L 的 COVID-19 患者中 25（OH）D 缺乏症患者的死亡率和严重程度比例。
在纳入的 23 项研究中（n=2692），平均年龄为 60.8（±15.9）岁，53.8%为男性。结果表明，维生素 25（OH）D 缺乏与严重 SARS-CoV-2 疾病（RR 2.00；95%CI 1.47-2.71，17 项研究）和死亡率（RR 2.45；95%CI 1.24-4.84，13 项研究）的风险增加相关。只有 7/23 项研究报告了 C-反应蛋白值，均>10mg/L。结论 25（OH）D 缺乏似乎与 SARS-CoV-2 感染严重程度和死亡率增加有关。然而，这些发现并不意味着因果关系，需要进行随机对照试验，并且应该设计新的研究来确定 25（OH）D 的减少是否是与 SARS-CoV-2 严重形式相关的炎症过程的伴随现象或结果。同时，25（OH）D 浓度可被视为 COVID-19 感染中的负急性相反应物和不良预后因素。
