Endocrine Abstracts

In March 2020, the infection due to COVID-19 spread as a pandemic emergence showing a mutable phenotype ranging from asymptomatic to lethal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Among multiple biological and environmental investigated factors, vitamin D status was proposed as a credible candidate, since hypovitaminosis D could be identified as a modifiable risk factor and a potential tool in SARS-CoV-2 prevention or ancillary treatment.

The aim of this study is to analyse the relationship between vitamin D status and a complete biochemical panel of immune system markers (pro and anti-inflammatory factors), in a cohort of patients with SARS-CoV-2. This was a retrospective, observational study conducted on available serum samples from consecutive patients with COVID-19 related pneumonia, admitted from March to May 2020 in two Hospital Units (Pulmonary and Geriatric Unit) in Pisa.

A total of 93 patients were included in the study, they were mainly males (n = 64, 68.8%) with a mean age of 68±16 years (median 69 i.r 57–80). Mean 25OHD was 17.3±10.7 ng/ml, with a median of 16.5 ng/ml (i.r. 7.9–23.2). Eighty-three patients had 25OHD levels ≤ 30 ng/ml (89%), 61 patients (65%) had 25OHD levels £20 ng/ml and 27 patients (29%) had 25OHD £10 ng/ml (severe vitamin D deficiency). Inflammatory markers were measured in all patients and compared between patients with 25OHD levels >20 ng/ml and those with ≤ 20 ng/ml. The latter showed significantly higher IL-6 [20.8 (10.9–45.6) vs 12.9 (8.7–21.1) pg/ml P = 0.02], CRP [10.7 (4.2–19.2) vs 5.9 (1.6–8.1) mg/dl P = 0.003], TNFα [8.9 (6.0–14.8) vs 4.4 (1.5–10.6) pg/ml P = 0.01], D-dimer [0.53 (0.25–0.72) vs 0.22 (0.17–0.35) mg/l P = 0.002] and IL-10 [3.7 (1.8–6.9) vs 2.3 (0.5–5.8) pg/ml P = 0.03] (Figure 1 panel A-E). In the overall group, an inverse correlation was found between 25OHD and IL-6 (r = –0.22, P = 0.03), between 25OHD and CRP (r = –0.21, P = 0.04), between 25OHD and D-dimer (r = –0.43, P = 0.001), between 25OHD and IL-10 (r = –0.25, P = 0.02) (Figure 2 panel A-D). These correlations remained statistically significant in a multivariate linear regression analysis, adjusted for age and gender [β=-0.64, P = 0.04 IL6; β=-0.17, P = 0.03 CRP; β=-0.017, P = 0.001 D-Dimer; β=-0.11, P = 0.02 IL-10]. In conclusion, hypovitaminosis D is related to the negative prognostic inflammatory status in patients with SARS-Cov2.