Type of publication:
*Moudgil N.; *Oyegunle T.; *Makan A.; *Crawford E.; *Srinivasan K.S.; *Ahmad N.; *Dev D.; *Moudgil H
American Journal of Respiratory and Critical Care Medicine; May 2021; vol. 203 (no. 9)
RATIONALE: Vitamin D supports immunity and inflammation by inhibiting proinflammatory cytokine release from macrophages and up-regulating the expression of anti-microbial peptides exhibiting anti-viral activity. Respiratory epithelial cells also convert inactive 25(OH)D (main circulating vitamin D) to 1,25(OH)2D3 enabling high local concentrations of this biologically active form to increase the expression of vitamin D-regulated genes. Studies continue to investigate the therapeutic effects and establish the optimal serum levels of 25(OH)D required to reduce the impact of respiratory tract infections whilst avoiding toxic hypercalcaemic high-dose 'blind' supplementation. Analysing patients admitted to hospital with COVID-19 (SARS-CoV-2 RNA) during the first phase of the pandemic, objectives and focus on reporting were to (1) document the population where measured vitamin D levels are readily available whilst quantifying those on supplements and (2) compare
outcome at discharge depending on most recent available vitamin D status. METHOD(S): Computer data including clinical outcomes were examined for the 516 patients (55% male) with mean age 67.4 (SD 18.3, range 0 to 100) years admitted from our semi-rural predominantly white European population to our District General Hospitals (Teaching) during the 4 months (March to June 2020) in the first phase of the COVID-19 illness in the UK. Outcomes (death during admission versus discharged alive) were analysed with SPSS comparing those with reduced versus adequate vitamin D levels. RESULT(S): Collectively (n=516), vitamin D levels (historical or updated) were available on 163 (31.5%) of patients; 17 (3.3%) undertaken during the admission. Data were skewed with median level 47 (interquartile range 24.1 to 66.9) nmol/L. 74 (14.3%) were already on vitamin D supplements and for an additional 10 (1.9%) this was initiated during the admission. Among the 163 patients, 86 (52.7%) had reduced vitamin D levels (deficient or insufficient) and these had worse outcomes with 29/86 (33.7%) having died during the admission compared with 13/74 (17.6%) of those with adequate levels: X2 (df 1, n=163) 6.02, p=.014. Table 1 categorises
distribution of values. CONCLUSION(S): Data highlight (1) less than a third of admitted COVID-19 patients have recorded vitamin D levels and of these more than half have reduced levels, (2) 14.3% are already taking vitamin D, (3) very few get
tested during the acute admission or get started on supplements, and (4) there is a statistical difference highlighting adverse outcome (death versus discharged alive) for those with reduced vitamin D levels.
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