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. 2023 Sep 1:14:1231813.
doi: 10.3389/fimmu.2023.1231813. eCollection 2023.

Association of serum vitamin D concentration with the final course of hospitalization in patients with COVID-19

Klaudia Konikowska  1 , Katarzyna Kiliś-Pstrusińska  2 , Agnieszka Matera-Witkiewicz  3 , Krzysztof Kujawa  4 , Barbara Adamik  5 , Adrian Doroszko  6 , Krzysztof Kaliszewski  7 , Michał Pomorski  8 , Marcin Protasiewicz  9 , Janusz Sokołowski  10 , Katarzyna Madziarska  11 , Ewa Anita Jankowska  9   12
Affiliations

Association of serum vitamin D concentration with the final course of hospitalization in patients with COVID-19

Klaudia Konikowska et al. Front Immunol. .

Abstract

Background: Vitamin D deficiency is a substantial public health problem. The present study evaluated the association between vitamin D concentration and hospitalization and mortality risk in patients with coronavirus disease 19 (COVID-19).

Methods: This study used the COronavirus in LOwer Silesia (COLOS) dataset collected between February 2020 and June 2021. The medical records of 474 patients with confirmed severe acute respiratory syndrome 2 (SARS-CoV-2) infection, and whose vitamin D concentration was measured, were analyzed.

Results: We determined a significant difference in vitamin D concentration between discharged patients and those who died during hospitalization (p = 0.0096). We also found an effect of vitamin D concentration on the risk of death in patients hospitalized due to COVID-19. As vitamin D concentration increased, the odds ratio (OR) for death slightly decreased (OR = 0.978; 95% confidence interval [CI] = 0.540-0.669). The vitamin D concentration cutoff point was 15.40 ng/ml. In addition, patients with COVID-19 and serum 25-hydroxyvitamin D (25(OH)D) concentrations < 30 ng/ml had a lower survival rate than those with serum 25(OH)D ≥ 30 ng/ml (log-rank test p = 0.0018). Moreover, a Cox regression model showed that patients with an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m2 and higher vitamin D concentrations had a 2.8% reduced risk of mortality (hazard ratio HR = 0.972; CI = 0.95-0,99; p = 0.0097).

Conclusions: The results indicate an association between 25(OH)D levels in patients with COVID-19 and the final course of hospitalization and risk of death.

Keywords: COVID-19; SARS-CoV-2; mortality; public health; vitamin D; vitamin D deficiency.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Area under the ROC curve of vitamin D serum level for in-hospital mortality of patients with COVID-19.
Figure 2
Figure 2
Breslow survival curves for patients with COVID-19 up to 90 days after hospitalization in relation to low (1st quartile Q1,) and high (3rd quartile Q3) vitamin D level, at constant eGFR level, equal to 76.2 mL/min/1.73m2 (arithmetic mean).
Figure 3
Figure 3
Kaplan–Meier survival analysis of COVID-19 patients until the 90th day from admission to hospital in relation to vitamin D concentration (<30 ng/ml and ≥ 30 ng/ml).
Figure 4
Figure 4
Adjusted hazard ratios (HR) for 90-day mortality in the group of patients with eGFR < 60 ml/min/1.73 m2. *p-value <0.05; **p-value <0.01.
Figure 5
Figure 5
Adjusted hazard ratios (HR) for 90-day mortality in the group of patients with eGFR ≥ 60 ml/min/1.73 m2. *p-value <0.05; **p-value <0.01; ***p-value <0.001.
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