Serum 25(OH)D Level on Hospital Admission Associated With COVID-19 Stage and Mortality

Abstract

Objectives: Vitamin D deficiency was previously correlated with incidence and severity of coronavirus disease 2019 (COVID-19). We investigated the association between serum 25-hydroxyvitamin D (25(OH)D) level on admission and radiologic stage and outcome of COVID-19 pneumonia.

Methods: A retrospective observational trial was done on 186 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals hospitalized from March 1, 2020, to April 7, 2020, with combined chest computed tomography (CT) and 25(OH)D measurement on admission. Multivariate regression analysis was performed to study if vitamin D deficiency (25(OH)D <20 ng/mL) correlates with survival independently of confounding comorbidities.

Results: Of the patients with COVID-19, 59% were vitamin D deficient on admission: 47% of females and 67% of males. In particular, male patients with COVID-19 showed progressively lower 25(OH)D with advancing radiologic stage, with deficiency rates increasing from 55% in stage 1 to 74% in stage 3. Vitamin D deficiency on admission was not confounded by age, ethnicity, chronic lung disease, coronary artery disease/hypertension, or diabetes and was associated with mortality (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.30-11.55), independent of age (OR, 1.09; 95% CI, 1.03-1.14), chronic lung disease (OR, 3.61; 95% CI, 1.18-11.09), and extent of lung damage expressed by chest CT severity score (OR, 1.12; 95% CI, 1.01-1.25).

Conclusions: Low 25(OH)D levels on admission are associated with COVID-19 disease stage and mortality.

Keywords: 25(OH)D; COVID-19 disease; Coronavirus; Laboratory analysis; SARS-CoV-2; Viral pneumonia; Vitamin D deficiency.

Image 1

Levels of 25-hydroxyvitamin D (25(OH)D) in male and female patients with coronavirus disease 2019 (COVID-19) grouped by radiologic COVID-19 disease stage. A-C, Representative images of radiologic stages of COVID-19 lung disease with predominantly ground-glass opacities in early stage 1 (A), crazy paving patterns in progressive stage 2 (B), and consolidation in peak stage 3 (C).

Figure 1

Box-and-whisker plots of 25-hydroxyvitamin D (25(OH)D) in male patients with coronavirus disease 2019 (COVID-19) (A) and female patients with COVID-19 (B) grouped according to radiologic stage (stage 1, early stage ground-glass opacities; stage 2, progressive stage, crazy paving pattern; stage 3, peak stage, consolidation). Background color in boxplots indicates normal vitamin D status (green, 25(OH)D >30 ng/mL), vitamin D deficiency (pale red, 25(OH)D <20 ng/mL), severe vitamin D deficiency (darker red, 25(OH)D <12 ng/mL), and a gray zone (20 ng/mL ≤ 25(OH)D ≤ 30 ng/mL). P values indicate statistical differences between groups calculated by the Mann-Whitney test. Exact P values are listed in the supplementary information.