Department of Pathology, Baylor Scott & White Central Texas, Temple, Texas, United States of America.
Baylor Scott & White Research Institute, Dallas, Texas, United States of America.
PLoS One. 2022 May 3;17(5):e0268038. doi: 10.1371/journal.pone.0268038. eCollection 2022.
Studies investigating the association between vitamin D and severity of COVID-19 have mixed results perhaps due to immunoassay assessment of total 25-hydroxyvitamin D (tD) (the sum of 25-hydroxyvitamin-D2 [25-OH-D2] and 25-hydroxyvitamin-D3 [25-OH-D3]). Liquid chromatography tandem mass spectrometry (LC-MS/MS) has high analytical specificity and sensitivity for 25-OH-D2 and 25-OH-D3, and thus enables a more accurate assessment of impact on COVID-19 outcomes.
We established reference intervals for 25-OH-D3 and tD using LC-MS/MS. 25-OH-D2, 25-OH-D3 and tD were quantitated for 88 COVID-19 positive and 122 COVID-19 negative specimens. Chi-square or Fisher's exact tests were used to test associations in binary variables. T-Tests or Wilcoxon rank sum tests were used for continuous variables. Cox proportional hazards were used to test associations between 25-OH-D3 or tD levels and length of stay (LOS). For mortality and ventilation, logistic regression models were used.
COVID-19 patients with deficient (<20 ng/mL) levels of 25-OH-D3 had significantly longer LOS by 15.3 days. COVID-19 P patients with deficient (<20 ng/mL) and insufficient (<30 ng/mL) of tD had significantly longer LOS by 12.1 and 8.2 days, respectively. Patients with insufficient levels of tD had significantly longer LOS by 13.7 days. COVID-19 patients with deficient serum 25-OH-D3 levels had significantly increased risk-adjusted odds of in-hospital mortality (OR [95% CI]: 5.29 [1.53-18.24]); those with insufficient 25-OH-D3 had significantly increased risk for requiring ventilation during hospitalization was found at LCMS insufficient cutoff (OR [95% CI]: 2.75 [1.10-6.90]).
There is an inverse relationship of 25-hydroxyvitamin D levels and hospital LOS for COVID-19 patients. Vitamin D status is a predictor for severity of outcomes. LCMS results are useful for assessing the odds of mortality and the need for ventilation during hospitalization.
研究维生素 D 与 COVID-19 严重程度之间关系的研究结果各异，这可能是由于总 25-羟维生素 D（tD）（25-羟维生素-D2[25-OH-D2]和 25-羟维生素-D3[25-OH-D3]的总和）的免疫测定评估所致。液相色谱串联质谱法（LC-MS/MS）对 25-OH-D2 和 25-OH-D3 具有高分析特异性和灵敏度，因此能够更准确地评估其对 COVID-19 结局的影响。
我们使用 LC-MS/MS 建立了 25-OH-D3 和 tD 的参考区间。对 88 例 COVID-19 阳性和 122 例 COVID-19 阴性标本进行了 25-OH-D2、25-OH-D3 和 tD 的定量检测。卡方检验或 Fisher 精确检验用于检验二分类变量的相关性。t 检验或 Wilcoxon 秩和检验用于连续变量。Cox 比例风险用于检验 25-OH-D3 或 tD 水平与住院时间（LOS）之间的相关性。对于死亡率和通气，使用 logistic 回归模型。
25-OH-D3 水平不足（<20ng/mL）的 COVID-19 患者 LOS 显著延长 15.3 天。25-OH-D3 和 tD 水平不足（<20ng/mL 和<30ng/mL）的 COVID-19 患者 LOS 分别显著延长 12.1 和 8.2 天。tD 水平不足的患者 LOS 显著延长 13.7 天。25-OH-D3 血清水平不足的 COVID-19 患者住院期间死亡率的风险调整比值比（OR）[95%CI]显著升高（5.29[1.53-18.24]）；在 LCMS 不足截点时，25-OH-D3 水平不足的患者住院期间需要通气的风险显著增加（OR[95%CI]：2.75[1.10-6.90]）。
COVID-19 患者 25-羟维生素 D 水平与住院 LOS 呈负相关。维生素 D 状态是严重程度结局的预测因子。LCMS 结果可用于评估住院期间死亡率和通气的可能性。
