Abstract
Little information is available on the beneficial effects of cholecalciferol treatment in comorbid patients hospitalized for COVID-19. The aim of this study was to retrospectively examine the clinical outcome of patients receiving in-hospital high-dose bolus cholecalciferol. Patients with a positive diagnosis of SARS-CoV-2 and overt COVID-19, hospitalized from 15 March to 20 April 2020, were considered. Based on clinical characteristics, they were supplemented (or not) with 400,000 IU bolus oral cholecalciferol (200,000 IU administered in two consecutive days) and the composite outcome (transfer to intensive care unit; ICU and/or death) was recorded. Ninety-one patients (aged 74 ± 13 years) with COVID-19 were included in this retrospective study. Fifty (54.9%) patients presented with two or more comorbid diseases. Based on the decision of the referring physician, 36 (39.6%) patients were treated with vitamin D. Receiver operating characteristic curve analysis revealed a significant predictive power of the four variables: (a) low (<50 nmol/L) 25(OH) vitamin D levels, (b) current cigarette smoking, (c) elevated D-dimer levels (d) and the presence of comorbid diseases, to explain the decision to administer vitamin D (area under the curve = 0.77, 95% CI: 0.67–0.87, p < 0.0001). Over the follow-up period (14 ± 10 days), 27 (29.7%) patients were transferred to the ICU and 22 (24.2%) died (16 prior to ICU and six in ICU). Overall, 43 (47.3%) patients experienced the combined endpoint of transfer to ICU and/or death. Logistic regression analyses revealed that the comorbidity burden significantly modified the effect of vitamin D treatment on the study outcome, both in crude (p = 0.033) and propensity score-adjusted analyses (p = 0.039), so the positive effect of high-dose cholecalciferol on the combined endpoint was significantly amplified with increasing comorbidity burden. This hypothesis-generating study warrants the formal evaluation (i.e., clinical trial) of the potential benefit that cholecalciferol can offer in these comorbid COVID-19 patients.
Highlights
The first cases of serious coronavirus disease-19 (COVID-19) secondary to acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection were reported in Wuhan, Hubei Province of China in January 2020 [1] where it subsequently spread worldwide [2,3]and was officially recognized as a pandemic by the WHO on 11th March 2020 [4].Patients with COVID-19 typically show clinical signs of severe respiratory illness manifestations including fever, non-productive cough, dyspnea, myalgia, fatigue, abnormal leukocyte counts and radiographic evidence of interstitial pneumonia, symptoms similar to the well-known SARS-CoV and MERS-CoV infections [5].SARS-CoV-2 infection can remain asymptomatic or cause modest symptoms
We observed that the comorbidity burden significantly modified the effect of vitamin D treatment on the incidence of the composite outcome of death from any cause and/or need for transfer to the intensive care unit (ICU) in COVID-19 patients, the OR of vitamin
Via immunomodulatory [37] and anti-inflammatory effects [15] that could well result in a clinically important benefit in COVID-19 patients with acute respiratory distress syndrome (ARDS) [13,38]. This present analysis follows in the footsteps of tentative evidence derived from a recent prospective study [30] and three clinical trials [31,32,33], two of which have shown benefit in patients hospitalized with COVID-19 following vitamin D supplementation
Summary
The first cases of serious coronavirus disease-19 (COVID-19) secondary to acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection were reported in Wuhan, Hubei Province of China in January 2020 [1] where it subsequently spread worldwide [2,3]and was officially recognized as a pandemic by the WHO on 11th March 2020 [4].Patients with COVID-19 typically show clinical signs of severe respiratory illness manifestations including fever, non-productive cough, dyspnea, myalgia, fatigue, abnormal leukocyte counts and radiographic evidence of interstitial pneumonia, symptoms similar to the well-known SARS-CoV and MERS-CoV infections [5].SARS-CoV-2 infection can remain asymptomatic or cause modest symptoms. The first cases of serious coronavirus disease-19 (COVID-19) secondary to acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection were reported in Wuhan, Hubei Province of China in January 2020 [1] where it subsequently spread worldwide [2,3]. Patients with COVID-19 typically show clinical signs of severe respiratory illness manifestations including fever, non-productive cough, dyspnea, myalgia, fatigue, abnormal leukocyte counts and radiographic evidence of interstitial pneumonia, symptoms similar to the well-known SARS-CoV and MERS-CoV infections [5]. Sick patients require hospital admission and about 20% of them will develop acute respiratory distress syndrome (ARDS) and require intensive care unit (ICU) treatment [6]. As of 16 December 2020, 1.64 million deaths have been reported worldwide with 68 million individuals testing positive for COVID-19 virus, 107,263 are in serious/critical condition and approximately 12,000 deaths are recorded daily worldwide. Was one of the first countries affected outside Asia and to date is one of the most affected countries in Europe alongside the United Kingdom, France and Spain where between 48,000 and 65,000 deaths have been reported for each of these countries as of
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