A Retrospective Analysis of Vitamin D Levels in Hospitalized COVID-19 Patients With Suspected Pulmonary Embolism

Abstract

Introduction Despite using anti-coagulation therapy in hospitalized coronavirus disease 2019 (COVID-19) patients, they have high rates of pulmonary embolism (PE) and deep vein thrombosis (DVT). The main objective of this study was to evaluate the association between vitamin D deficiency and thrombotic events (defined as the occurrence of a new PE or DVT) in hospitalized COVID-19 patients. Materials and Methods This was a retrospective, cross-sectional study of 208 hospitalized COVID-19 patients who received a computed tomographic pulmonary angiography (CTPA) based on clinical suspicion of PE between January 1, 2020, and February 5, 2021. A <20 ng/mL serum vitamin D level was used to categorize vitamin D deficiency. Nonparametric tests and multivariate binary logistic regression were used to evaluate the association between serum vitamin D levels and clinical outcomes. Results The mean vitamin D level was 26.7±13.0 ng/mL (n=208), and approximately one-third of patients were vitamin D deficient (n=68, 32.7%). No association was found between vitamin D deficiency and the occurrence of thrombotic events. The incidence of PE was 19.1% in vitamin D deficient patients compared to 11.4% in vitamin D sufficient patients (p=0.13). Vitamin D deficiency was positively associated with ICU admission (OR 3.047, 95%CI 1.57-5.91, p=0.001) and mortality (OR 3.76, 95%CI 1.29-11.01, p=0.016). Conclusions This study found no association between vitamin D deficiency and the occurrence of a new PE or DVT in hospitalized COVID-19 patients. Patients with vitamin D deficiency were more likely to be admitted to the ICU and had increased overall mortality.

Keywords: american thoracic society; area deprivation index; covid-19; deep vein thrombosis; icu; pulmonary embolism; vitamin d.

Figure 1. Flow chart depicting inclusion criteria

Adult patients (≥18 years of age) with a confirmed COVID-19 diagnosis who had a CTPA to rule out PE during their hospitalization and a documented vitamin D level in the past year were included. COVID-19: coronavirus disease 2019; CTPA: computed tomography pulmonary angiography; PE: pulmonary embolism

Figure 2. Vitamin D distribution across ADI

Vitamin D deficient: blue, <20 ng/ml; Vitamin D sufficient: orange, ≥ 20 ng/ml Total patients living in high area deprivation = 79; Total patients living in medium area deprivation = 88; Total patients living in low area deprivation = 38. ADI: Area Deprivation Index