Background: The pandemic of Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is associated with higher fatality in respect of male sex, advancing age, obesity, diabetes, hypertension, climatic factors and, in the UK and North America, with darker-skinned ethnicities; in all of which circumstances vitamin D deficiency (VDD) is more common. 25(OH)D levels reach their nadir at the end of winter and have been associated with increased risk of acute respiratory tract infections, which is mitigated by vitamin D supplementation. As seasonal VDD is highly prevalent in North-East England, physicians in Newcastle-upon-Tyne Hospitals (NuTH), a large tertiary NHS centre, decided to measure admission serum 25(OH)D levels in patients with COVID-19, to inform a treatment protocol adjusted according to the severity of baseline deficiency.
Objectives: To evaluate implementation of a local protocol for treatment of VDD among inpatients with COVID-19; to assess the prevalence of VDD, and examine potential associations with disease severity and fatality.
Methods: We performed a retrospective interim audit of a local care pathway for hospitalized patients with COVID-19-related illness. 134 patients with documented COVID-19 infection were included. We determined the prevalence of VDD, implementation of the local treatment protocol and relationship of baseline serum 25(OH)D with markers of COVID-19 severity and inpatient fatality vs recovery.
Results: 55.8% of eligible patients received Colecalciferol replacement, albeit not always loaded as rapidly as our protocol suggested. No cases of new hypercalcaemia occurred following treatment. Patients admitted to ITU were younger than those managed on medical wards (61.1 years ± 11.8 vs 76.4 years ± 14.9, P < 0.001), with greater prevalence of hypertension, higher baseline respiratory rate, National Early Warning Score-2 and C-reactive protein level. While mean serum 25(OH)D levels were comparable [ITU: 33.3 nmol/l, 95% Confidence Interval (CI) 28.0–38.5 nmol/l vs Non-ITU: 48.2 nmol/l, 95% CI 40.3–56.0 nmol/l, P = 0.2) only 19% of ITU patients had 25(OH)D levels greater than 50 nmol/l vs 39.1% of non-ITU patients (P = 0.02). However, there was no association with fatality, potentially due to small sample size and prompt diagnosis and treatment of VDD.
Conclusions: Patients requiring ITU admission were more frequently vitamin D deficient than patients on medical wards, despite being significantly younger. These data suggest an important association between VDD and COVID-19 severity. Larger prospective studies and/or clinical trials are urgently needed to elucidate the role of vitamin D as a preventive and/or therapeutic strategy for mitigating the effects of COVID-19 infection.
05 - 09 Sep 2020
European Society of Endocrinology