Blázquez-Cabrera José Antonio, Torres-Hernández Javier, Bouillon Roger, Casado-Díaz Antonio, Quesada-Gomez José Manuel, Navarro-Casado Laura
Internal Medicine Department, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain.
Clinical Biochemistry Department, Complejo Hospitalario Universitario de Albacete, 02008 Albacete, Spain.
Nutrients. 2025 Jun 10;17(12):1968. doi: 10.3390/nu17121968.
Immunomodulatory treatments targeting excessive host immune responses favorably shifting the course of COVID-19. High doses of calcifediol may reduce the mortality of this infection. To evaluate how a high dose of calcifediol modifies the risk of death in patients hospitalized with COVID-19 during the first outbreaks. A retrospective, observational study to evaluate the relationship between treatment with calcifediol and the risk of death in patients hospitalized with COVID-19 at the "Complejo Hospitalario Universitario de Albacete" (CHUA), Spain, during the months of January to March 2021. Patients were treated with corticosteroids, and some patients also received baricitinib and/or high doses of calcifediol, according to CHUA's therapeutic protocol 2021 for COVID-19. The primary outcome measure was mortality according to calcifediol treatment. A total of 230 patients were included. 25(OH)D levels were measured on admission in 148 patients, showing a high prevalence of vitamin D deficiency [median 25(OH)D: 17.5 ng/mL]. Thirty-four (23%) had severe deficiency (25(OH)D ≤ 10 ng/mL). In the 119 patients (51.7%) who received in-hospital treatment with a high dose of calcifediol, the mortality rate was 12.6% (15 cases, 95% confidence interval [CI], 7.8-19.8%), while in 111 patients who did not receive treatment with calcifediol, the death rate was 23.4% (26 cases, 95% CI: 16.5-32.1%; = 0.039). The odds ratio (OR) in treated vs. untreated patients was 0.47 (95% CI: 0.23-0.95). Among the patients admitted with severe deficiency, 16 received treatment with calcifediol, with a mortality rate of 0.0% (0 cases, 95% CI: 0.0-19.4%), while in the 18 not treated with calcifediol, a death rate of 38.9% was observed (7 cases, 95% CI: 20.3-61.4%; = 0.008). The mortality rate was lower in patients treated with the combination of calcifediol and corticosteroids vs. those treated with corticosteroids alone ( = 0.038) and vs. those treated with corticosteroids and baricitinib ( = 0.033). In the ALBACOVIDIOL study, calcifediol treatment was associated with a lower observed mortality rate in hospitalized patients with COVID-19 treated with corticosteroids (with or without baricitinib), especially in those with severe vitamin D deficiency. Causality cannot be inferred due to the retrospective study design. (Public database: ClinicalTrials.gov, NCT05819918).
针对过度的宿主免疫反应的免疫调节治疗有利于改变新冠病毒疾病（COVID-19）的病程。高剂量的骨化二醇可能会降低这种感染的死亡率。为了评估高剂量骨化二醇如何改变首次疫情期间因COVID-19住院患者的死亡风险。这是一项回顾性观察研究，旨在评估2021年1月至3月期间在西班牙阿尔瓦塞特大学综合医院（CHUA）因COVID-19住院的患者中，骨化二醇治疗与死亡风险之间的关系。根据CHUA 2021年的COVID-19治疗方案，患者接受了皮质类固醇治疗，一些患者还接受了巴瑞替尼和/或高剂量骨化二醇治疗。主要结局指标是根据骨化二醇治疗情况的死亡率。共纳入230例患者。148例患者入院时测量了25(OH)D水平，显示维生素D缺乏患病率很高[25(OH)D中位数：17.5 ng/mL]。34例（23%）有严重缺乏（25(OH)D≤10 ng/mL）。在119例（51.7%）住院期间接受高剂量骨化二醇治疗的患者中，死亡率为12.6%（15例，95%置信区间[CI]，7.8-19.8%），而在111例未接受骨化二醇治疗的患者中，死亡率为23.4%（26例，95%CI：16.5-32.1%；P = 0.039）。接受治疗与未接受治疗患者的比值比（OR）为0.47（95%CI：0.23-0.95）。在严重缺乏的入院患者中，16例接受了骨化二醇治疗，死亡率为0.0%（0例，95%CI：0.0-19.4%），而在18例未接受骨化二醇治疗的患者中，观察到死亡率为38.9%（7例，95%CI：20.3-61.4%；P = 0.008）。与单独接受皮质类固醇治疗的患者相比（P = 0.038）以及与接受皮质类固醇和巴瑞替尼治疗的患者相比（P = 0.033），接受骨化二醇和皮质类固醇联合治疗患者亚组的死亡率更低。在ALBACOVIDIOL研究中，骨化二醇治疗与接受皮质类固醇（有或没有巴瑞替尼）治疗的COVID-19住院患者中观察到的较低死亡率相关，尤其是在那些严重维生素D缺乏的患者中。由于回顾性研究设计，无法推断因果关系。（公共数据库：ClinicalTrials.gov，NCT05819918）
