Chen I-Wen, Yu Ting-Sian, Lai Yi-Chen, Yang Chih-Ping, Yu Chia-Hung, Hung Kuo-Chuan
Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
Front Nutr. 2025 Jun 18;12:1583276. doi: 10.3389/fnut.2025.1583276. eCollection 2025.
BACKGROUND: Vitamin D deficiency (VDD) has been associated with adverse outcomes in COVID-19 patients during the early pandemic phases, but whether this association persists in the post-Omicron era remains uncertain. This study aimed to investigate the evolving relationship between VDD and COVID-19 outcomes across pandemic phases using a large healthcare database. METHODS: We conducted a retrospective cohort study using the TriNetX Analytics Network, analyzing propensity-matched cohorts comprising 24,236 pairs from the post-Omicron phase (June 2022-December 2023) and 22,638 pairs from the pre-Omicron phase (January 2020-December 2021). VDD was defined as a serum 25-hydroxyvitamin D level < 20 ng/ml, with vitamin D-sufficient patients (≥30 ng/ml) serving as controls. The primary outcome was 30-day all-cause mortality, with secondary outcomes including acute kidney injury, respiratory failure, pneumonia, sepsis, and ICU admission. RESULTS: The 30-day mortality in VDD vs. vitamin D-sufficient patients decreased from 1.43% vs. 0.39% [odds ratio (OR), 3.67; 95% CI, 2.90-4.64; < 0.001] in the pre-Omicron phase to 0.89% vs. 0.49% (OR, 1.82; 95% CI, 1.46-2.28; < 0.001) in the post-Omicron phase. Similar risk attenuation was observed across all secondary outcomes, including acute kidney injury (OR, 2.11; 95% CI, 1.92-2.31 vs. OR, 1.41; 95% CI, 1.29-1.54; both < 0.001), respiratory failure (OR, 1.66; 95% CI, 1.44-1.92 vs. OR, 1.34; 95% CI, 1.16-1.54; both < 0.001), and pneumonia (OR, 1.34; 95% CI, 1.16-1.55 vs. OR, 1.23; 95% CI, 1.07-1.42; < 0.001 and = 0.004, respectively). Risk factor analysis identified several significant mortality predictors among patients with VDD in the post-Omicron phase, including malnutrition (OR, 4.34; 95% CI, 3.18-5.92; < 0.001), liver disease (OR, 3.08; 95% CI, 2.23-4.25; < 0.001), and neoplasms (OR, 2.63; 95% CI, 2.01-3.45; < 0.001). CONCLUSION: VDD continues to be associated with adverse COVID-19 outcomes in the post-Omicron phase, albeit with a reduced magnitude. These findings support the importance of vitamin D screening in high-risk COVID-19 patients, while emphasizing the need for adaptive risk assessment strategies that incorporate both established and emerging risk factors in the current pandemic landscape.
背景：在新冠疫情早期阶段，维生素D缺乏（VDD）与新冠患者的不良预后相关，但在奥密克戎毒株出现后的时期这种关联是否持续仍不确定。本研究旨在利用一个大型医疗数据库调查疫情各阶段VDD与新冠预后之间不断演变的关系。 方法：我们使用TriNetX分析网络进行了一项回顾性队列研究，分析了倾向匹配队列，其中包括来自奥密克戎毒株出现后阶段（2022年6月至2023年12月）的24236对和奥密克戎毒株出现前阶段（2020年1月至2021年12月）的22638对。VDD被定义为血清25-羟维生素D水平<20 ng/ml，维生素D充足的患者（≥30 ng/ml）作为对照。主要结局是30天全因死亡率，次要结局包括急性肾损伤、呼吸衰竭、肺炎、脓毒症和入住重症监护病房。 结果：VDD患者与维生素D充足患者的30天死亡率从奥密克戎毒株出现前阶段的1.43%对0.39%[比值比（OR），3.67；95%置信区间（CI），2.90 - 4.64；P<0.001]降至奥密克戎毒株出现后阶段的0.89%对0.49%（OR，1.82；95%CI，1.46 - 2.28；P<0.001）。在所有次要结局中均观察到类似的风险降低，包括急性肾损伤（OR，2.11；95%CI，1.92 - 2.31对OR，1.41；95%CI，1.29 - 1.54；均P<0.001）、呼吸衰竭（OR，1.66；95%CI，1.44 - 1.92对OR，1.34；95%CI，1.16 - 1.54；均P<0.001）和肺炎（OR，1.34；95%CI，1.16 - 1.55对OR，1.23；95%CI，1.07 - 1.42；分别为P<0.001和P = 0.004）。风险因素分析确定了奥密克戎毒株出现后阶段VDD患者中的几个显著死亡预测因素，包括营养不良（OR，4.34；95%CI，3.18 - 5.92；P<0.001）、肝病（OR，3.08；95%CI，2.23 - 4.25；P<0.001）和肿瘤（OR，2.63；95%CI，2.01 - 3.45；P<0.001）。 结论：在奥密克戎毒株出现后阶段，VDD仍然与新冠不良预后相关，尽管关联程度有所降低。这些发现支持了对高危新冠患者进行维生素D筛查的重要性，同时强调需要采用适应性风险评估策略，将当前疫情形势下既有的和新出现的风险因素都纳入其中。
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