Papadimitriou Dimitrios T, Vassaras Alexandros K, Holick Michael F
Pediatric - Adolescent Endocrinology and Diabetes, Athens Medical Center, Marousi 15125, Greece.
Neurology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece.
World J Virol. 2021 May 25;10(3):111-129. doi: 10.5501/wjv.v10.i3.111.
Vitamin D population status may have possible unappreciated consequences to the coronavirus disease 2019 (COVID-19) pandemic. Α significant association between vitamin D sufficiency and reduction in clinical severity and inpatient mortality from COVID-19 disease has recently been shown, while a recent study has claimed lower COVID-19 cases in European countries with a better vitamin D status. Low serum 25-hydroxyvitamin-D [25(OH)D] was identified as an independent risk factor for COVID-19 infection and hospitalization, and administration of 0.532 mg (21280 IU) of calcifediol or 25(OH)D, followed by 0.266 mg on days 3 and 7 and then weekly until discharge or intensive care unit admission significantly reduced the need for intensive care unit treatment.
To elucidate the role of vitamin D European population status in the COVID-19 pandemic, data from the Worldometer were analyzed.
Linear regression explored the correlation between published representative-standardized population vitamin D concentrations and the number of total cases/million (M), recovered/M, deaths/M and serious-critically ill/M from COVID-19 for 26 European countries populated > 4 M (Worldometer). Life expectancy was analyzed with semi-parametric regression. Weighted analysis of variance/analysis of covariance evaluated serious-critical/M and deaths/M by the vitamin D population status: Deficient < 50, insufficient: 50-62.5, mildly insufficient > 62.5-75 and ufficient > 75 nmol/L, while controlling for life expectancy for deaths/M. Statistical analyses were performed in XLSTAT LIFE SCIENCE and R (SemiPar Library).
Linear regression found no correlation between population vitamin D concentrations and the total cases-recovered/M, but negative correlations predicting a reduction of 47%-64%-80% in serious-critical illnesses/M and of 61%-82%-102.4% in deaths/M further enhanced when adapting for life expectancy by 133-177-221% if 25(OH)D concentrations reach 100-125-150 nmol/L, sustained on August 15, 2020, indicating a truthful association. Weighted analysis of variance was performed to evaluate serious-critical/M ( = 0.22) by the vitamin D population status and analysis of covariance the deaths/M ( = 0.629) controlling for life expectancy ( = 0.47). Serious-critical showed a decreasing trend ( < 0.001) from population status deficient ( < 0.001) to insufficient by 9.2% ( < 0.001), to mildly insufficient by 47.6% ( < 0.044) and to sufficient by 100% (reference, < 0.001). For deaths/M the respective decreasing trend ( < 0.001) was 62.9% from deficient ( < 0.001) to insufficient ( < 0.001), 65.15% to mildly insufficient ( < 0.001) and 78.8% to sufficient ( = 0.041).
Achieving serum 25(OH)D 100-150 nmol/L (40-60 ng/mL) (upper tolerable daily doses followed by maintenance proposed doses not requiring medical supervision, Endocrine Society) may protect from serious-critical illness/death from COVID-19 disease.
维生素D的人群状况可能对2019冠状病毒病（COVID-19）大流行产生未被充分认识的影响。最近的研究表明，维生素D充足与COVID-19疾病临床严重程度降低及住院死亡率降低之间存在显著关联，同时，一项近期研究称，在维生素D状况较好的欧洲国家，COVID-19病例较少。低血清25-羟基维生素D[25(OH)D]被确定为COVID-19感染和住院的独立危险因素，给予0.532毫克（21280国际单位）骨化二醇或25(OH)D，然后在第3天和第7天给予0.266毫克，之后每周一次，直至出院或入住重症监护病房，显著降低了对重症监护病房治疗的需求。
为阐明欧洲人群维生素D状况在COVID-19大流行中的作用，分析了来自世界ometers的数据。
线性回归分析了26个人口超过400万的欧洲国家（世界ometers）已发表的代表性标准化人群维生素D浓度与COVID-19的每百万总病例数、康复数、死亡数和重症数之间的相关性。采用半参数回归分析预期寿命。通过方差加权分析/协方差分析评估维生素D人群状况下的重症数和死亡数：缺乏<50、不足：50-62.5、轻度不足>62.5-75和充足>75纳摩尔/升，同时控制死亡数的预期寿命。在XLSTAT生命科学和R（SemiPar库）中进行统计分析。
线性回归发现人群维生素D浓度与每百万康复总病例数之间无相关性，但预测重症数降低47%-64%-80%和死亡数降低61%-82%-102.4%的负相关性在根据预期寿命进行调整后进一步增强，如果25(OH)D浓度在2020年8月15日达到100-125-150纳摩尔/升，则增强133%-177%-221%，表明存在真实关联。采用方差加权分析评估维生素D人群状况下的重症数（P=0.22），采用协方差分析评估控制预期寿命后的死亡数（P=0.629）（P=0.47）。重症数从缺乏状态（P<0.001）到不足状态呈下降趋势（P<0.001），下降9.2%（P<0.001），到轻度不足状态下降47.6%（P<0.044），到充足状态下降100%（参照，P<0.001）。对于每百万死亡数，相应的下降趋势（P<0.001）分别为：从缺乏到不足下降62.9%（P<0.001），到轻度不足下降65.15%（P<0.001），到充足下降78.8%（P=0.041）。
使血清25(OH)D达到100-150纳摩尔/升（40-60纳克/毫升）（内分泌学会建议的可耐受每日高剂量及维持剂量，无需医学监督）可能预防COVID-19疾病导致的重症/死亡。
