Institute of Endocrine and Metabolic Sciences, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy.
Laboratory Medicine Service, IRCCS Ospedale San Raffaele, Milan, Italy.
Endocrine. 2023 Jun;80(3):669-683. doi: 10.1007/s12020-023-03331-9. Epub 2023 Mar 1.
Low vitamin D in COVID-19 have been related to worse outcomes. However, most of the studies conducted so far were not-controlled and retrospective, including biases potentially influencing this association. We evaluated 25(OH)vitamin D levels of patients with both severe and non-severe disease at hospital-admission, and in a cohort of control subjects. Moreover, we evaluated sACE-2 levels to investigate the mechanisms underlying the association between vitamin D and COVID-19.
COVID-19 patients were enrolled in a matched for age, sex and comorbidities 1:1-ratio based on the presence/or not of respiratory-distress/severe-disease at hospital-admission. Control matched subjects were enrolled from an outpatient-setting.
Seventy-three COVID-19 patients (36 severe and 37 non-severe) and 30 control subjects were included. We observed a higher vitamin D deficiency (<20 ng/mL) prevalence in COVID-19 patients than control subjects (75% vs 43%). No differences were found regarding 25(OH)vitamin D and sACE-2 levels between patients with and without severe-disease at study entry. During the disease-course, in the severe group a life-threatening disease occurred in 17 patients (47.2%), and, in the non-severe group, a worsening disease occurred in 10 (27%). 25(OH)vitamin D levels, at admission, were negatively correlated with sACE-2 levels, and were lower in patients whose disease worsened as compared to those in whom it did not, independently from the disease severity at admission. In multivariate-analysis, lower 25(OH)vitamin D resulted as an independent risk factor for disease worsening.
25(OH)vitamin D levels at hospital-admission strongly predicted the occurrence of worsening outcomes in COVID-19 independently of the disease severity at presentation.
COVID-19 患者维生素 D 水平较低与预后较差有关。然而，迄今为止进行的大多数研究都是非对照和回顾性的，包括可能影响这种关联的潜在偏倚。我们评估了入院时重症和非重症 COVID-19 患者以及对照组患者的 25(OH)维生素 D 水平。此外，我们评估了 sACE-2 水平，以研究维生素 D 与 COVID-19 之间关联的潜在机制。
COVID-19 患者根据入院时是否存在呼吸窘迫/重症，按年龄、性别和合并症 1:1 配对纳入研究。对照组患者从门诊环境中招募。
共纳入 73 例 COVID-19 患者（36 例重症和 37 例非重症）和 30 例对照组患者。与对照组相比，COVID-19 患者维生素 D 缺乏（<20ng/ml）的发生率更高（75%比 43%）。入院时无重症和重症患者的 25(OH)维生素 D 和 sACE-2 水平无差异。在疾病过程中，重症组有 17 例（47.2%）患者发生危及生命的疾病，而非重症组有 10 例（27%）患者病情恶化。入院时 25(OH)维生素 D 水平与 sACE-2 水平呈负相关，与病情未恶化的患者相比，病情恶化的患者 25(OH)维生素 D 水平较低，且与入院时疾病严重程度无关。多变量分析显示，入院时 25(OH)维生素 D 水平较低是病情恶化的独立危险因素。
入院时 25(OH)维生素 D 水平强烈预测 COVID-19 患者不良结局的发生，与入院时疾病严重程度无关。
