Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Applied Physiology and Nutrition Research Group, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Am J Clin Nutr. 2021 Aug 2;114(2):598-604. doi: 10.1093/ajcn/nqab151.
Vitamin D acts as a mediator in the immune system regulating antiviral mechanisms and inflammatory processes. Vitamin D insufficiency has been suggested as a potential risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, although its impact on the prognosis of hospitalized patients with coronavirus disease 2019 (COVID-19) remains unclear.
This multicenter prospective cohort study was designed to investigate whether serum 25-hydroxyvitamin D [25(OH)D] concentration is associated with hospital length of stay and prognosis in hospitalized patients with COVID-19.
Patients with moderate to severe COVID-19 (n = 220) were recruited from 2 hospitals in Sao Paulo, Brazil. Serum 25(OH)D concentrations were categorized as follows: <10 ng/mL, 10 to <20 ng/mL, 20 to <30 ng/mL, and ≥30 ng/mL, and <10 ng/mL and ≥10 ng/mL. The primary outcome was hospital length of stay and the secondary outcomes were the rate of patients who required invasive mechanical ventilation and mortality.
There were no significant differences in hospital length of stay when the 4 25(OH)D categories were compared (P = 0.120). Patients exhibiting 25(OH)D <10 ng/mL showed a trend (P = 0.057) for longer hospital length of stay compared with those with 25(OH)D ≥10 ng/mL [9.0 d (95% CI: 6.4, 11.6 d) vs. 7.0 d (95% CI: 6.6, 7.4 d)]. The multivariable Cox proportional hazard models showed no significant associations between 25(OH)D and primary or secondary outcomes.
Among hospitalized patients with moderate to severe COVID-19, those with severe 25(OH)D deficiency (<10 ng/mL) exhibited a trend for longer hospital length of stay compared with patients with higher 25(OH)D concentrations. This association was not significant in the multivariable Cox regression model. Prospective studies should test whether correcting severe 25(OH)D deficiency could improve the prognosis of patients with COVID-19.
维生素 D 作为免疫系统的调节剂，调节抗病毒机制和炎症过程。维生素 D 不足被认为是严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染的潜在危险因素，尽管其对 2019 冠状病毒病（COVID-19）住院患者预后的影响尚不清楚。
本多中心前瞻性队列研究旨在探讨血清 25-羟维生素 D [25(OH)D]浓度与 COVID-19 住院患者的住院时间和预后是否相关。
从巴西圣保罗的 2 家医院招募了 220 名中重度 COVID-19 患者。血清 25(OH)D 浓度分为以下几类：<10ng/mL、10-<20ng/mL、20-<30ng/mL 和≥30ng/mL，以及<10ng/mL 和≥10ng/mL。主要结局是住院时间，次要结局是需要有创机械通气的患者比例和死亡率。
当比较 4 个 25(OH)D 类别时，住院时间无显著差异（P=0.120）。与 25(OH)D≥10ng/mL 相比，25(OH)D<10ng/mL 患者的住院时间有延长的趋势（P=0.057）[9.0 d（95%CI：6.4，11.6 d）比 7.0 d（95%CI：6.6，7.4 d）]。多变量 Cox 比例风险模型显示 25(OH)D 与主要或次要结局之间无显著关联。
在中重度 COVID-19 住院患者中，与较高 25(OH)D 浓度患者相比，严重 25(OH)D 缺乏症（<10ng/mL）患者的住院时间有延长趋势。但这种关联在多变量 Cox 回归模型中并不显著。前瞻性研究应检测纠正严重 25(OH)D 缺乏是否能改善 COVID-19 患者的预后。
