骨化二醇治疗与 COVID-19 相关结局。

Calcifediol Treatment and COVID-19-Related Outcomes.

机构信息

IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Barcelona 08003, Spain.

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain.

出版信息

J Clin Endocrinol Metab. 2021 Sep 27;106(10):e4017-e4027. doi: 10.1210/clinem/dgab405.

DOI:10.1210/clinem/dgab405

PMID:34097036

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8344647/

Abstract

CONTEXT

COVID-19 is a major health problem because of saturation of intensive care units (ICU) and mortality. Vitamin D has emerged as a potential treatment able to reduce the disease severity.

OBJECTIVE

This work aims to elucidate the effect of 25(OH)D3 (calcifediol) treatment on COVID-19-related outcomes.

METHODS

This observational cohort study was conducted from March to May 2020, among patients admitted to COVID-19 wards of Hospital del Mar, Barcelona, Spain. A total of 930 patients with COVID-19 were included; 92 were excluded because of previous calcifediol intake. Of the remaining 838, a total of 447 received calcifediol (532 μg on day 1 plus 266 μg on days 3, 7, 15, and 30), whereas 391 were not treated at the time of hospital admission (intention-to-treat). Of the latter, 53 patients were treated later during ICU admission and were allocated in the treated group in a second analysis. In healthy individuals, calcifediol is about 3.2-fold more potent on a weight basis than cholecalciferol. Main outcome measures were ICU admission and mortality.

RESULTS

ICU assistance was required by 102 (12.2%) participants. Out of 447 patients treated with calcifediol at admission, 20 (4.5%) required the ICU, compared to 82 (21%) out of 391 nontreated (P < .001). Logistic regression of calcifediol treatment on ICU admission, adjusted by age, sex, linearized 25-hydroxyvitamin D levels at baseline, and comorbidities showed that treated patients had a reduced risk of requiring the ICU (odds ratio [OR] 0.13; 95% CI 0.07-0.23). Overall mortality was 10%. In the intention-to-treat analysis, 21 (4.7%) out of 447 patients treated with calcifediol at admission died compared to 62 patients (15.9%) out of 391 nontreated (P = .001). Adjusted results showed a reduced mortality risk with an OR of 0.21 (95% CI, 0.10-0.43). In the second analysis, the obtained OR was 0.52 (95% CI, 0.27-0.99).

CONCLUSION

In patients hospitalized with COVID-19, calcifediol treatment significantly reduced ICU admission and mortality.

摘要

背景

COVID-19 是一个重大的健康问题，因为重症监护病房（ICU）饱和和死亡率高。维生素 D 已成为一种潜在的治疗方法，能够降低疾病严重程度。

目的

本研究旨在阐明 25(OH)D3（calcifediol）治疗对 COVID-19 相关结局的影响。

方法

这项观察性队列研究于 2020 年 3 月至 5 月在西班牙巴塞罗那的 Hospital del Mar 的 COVID-19 病房进行，共纳入 930 例 COVID-19 患者，92 例因先前摄入 calcifediol 而被排除在外。在剩余的 838 名患者中，共有 447 名接受了 calcifediol 治疗（第 1 天给予 532μg，第 3、7、15 和 30 天给予 266μg），而在入院时未接受治疗的有 391 名（意向治疗）。在后者中，53 名患者在 ICU 入院期间接受了治疗，并在第二次分析中被分配到治疗组。在健康个体中，calcifediol 的效力比胆钙化醇高约 3.2 倍。主要观察指标为 ICU 入院和死亡率。

结果

102 名（12.2%）参与者需要 ICU 辅助治疗。在入院时接受 calcifediol 治疗的 447 名患者中，有 20 名（4.5%）需要进入 ICU，而在未接受治疗的 391 名患者中，有 82 名（21%）需要进入 ICU（P<.001）。对接受 calcifediol 治疗的患者进行 ICU 入院的 logistic 回归分析，调整了年龄、性别、基线线性 25-羟维生素 D 水平和合并症，结果表明，接受治疗的患者进入 ICU 的风险降低（比值比[OR]0.13；95%CI0.07-0.23）。总死亡率为 10%。在意向治疗分析中，在入院时接受 calcifediol 治疗的 447 名患者中，有 21 名（4.7%）死亡，而在未接受治疗的 391 名患者中，有 62 名（15.9%）死亡（P=0.001）。调整后的结果显示，死亡风险降低，OR 为 0.21（95%CI0.10-0.43）。在第二次分析中，获得的 OR 为 0.52（95%CI0.27-0.99）。