Vitamin D and Lung Outcomes in Elderly COVID-19 Patients

Alberto Sulli; Emanuele Gotelli; Andrea Casabella; Sabrina Paolino; Carmen Pizzorni; Elisa Alessandri; Marco Grosso; Diego Ferone; Vanessa Smith; Maurizio Cutolo

doi:10.3390/nu13030717

Vitamin D and Lung Outcomes in Elderly COVID-19 Patients

Nutrients. 2021 Feb 24;13(3):717. doi: 10.3390/nu13030717.

Affiliations

¹ Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic, 16132 Genova, Italy.
² Pneumology Unit, IRCCS San Martino Polyclinic, 16132 Genova, Italy.
³ Endocrinology Unit, Department of Internal Medicine, University of Genova, IRCCS San Martino Polyclinic, 16132 Genova, Italy.
⁴ Department of Rheumatology, Ghent University Hospital, Department of Internal Medicine, VIB Inflammation Research Centre Ghent University, 9000 Ghent, Belgium.

Abstract

Background and aim: Vitamin D deficiency is frequently reported in patients with SARS-CoV-2 infection. The aim of this study was to correlate the 25OH-Vitamin D serum concentrations with clinical parameters of lung involvement, in elderly patients hospitalized for SARS-CoV-2 infection. Methods: Sixty-five consecutive COVID-19 patients (mean age 76 ± 13 years) and sixty-five sex- and age-matched control subjects (CNT) were analyzed. The following clinical parameters, including comorbidities, were collected at admission: type of pulmonary involvement, respiratory parameters (PaO₂, SO₂, PaCO₂, PaO₂/FiO₂), laboratory parameters (including 25OH-vitamin D, D-dimer, C-reactive protein). Results: Significantly lower vitamin D serum levels were found in COVID-19 patients than in CNT (median 7.9 vs 16.3 ng/mL, p = 0.001). Interestingly, a statistically significant positive correlation was observed between vitamin D serum levels and PaO₂ (p = 0.03), SO₂ (p = 0.05), PaO₂/FiO₂ (p = 0.02), while a statistically significant negative correlation was found between vitamin D serum levels and D-dimer (p = 0.04), C-reactive protein (p = 0.04) and percentage of O₂ in a venturi mask (p = 0.04). A negative correlation was also observed between vitamin D serum levels and severity of radiologic pulmonary involvement, evaluated by computed tomography: in particular, vitamin D was found significantly lower in COVID-19 patients with either multiple lung consolidations (p = 0.0001) or diffuse/severe interstitial lung involvement than in those with mild involvement (p = 0.05). Finally, significantly lower vitamin D serum levels were found in the elderly COVID-19 patients who died during hospitalization, compared to those who survived (median 3.0 vs 8.4 ng/mL, p = 0.046). Conclusions: This study confirms that 25OH-vitamin D serum deficiency is associated with more severe lung involvement, longer disease duration and risk of death, in elderly COVID-19 patients. The detection of low vitamin D levels also in younger COVID-19 patients with less comorbidities further suggests vitamin D deficiency as crucial risk factor at any age.

Keywords: COVID-19; SARS-CoV-2; Vitamin D; disease severity; lung involvement.

Publication types

Clinical Trial

MeSH terms

Age Factors
Aged
Aged, 80 and over
COVID-19* / blood
COVID-19* / diagnostic imaging
COVID-19* / mortality
COVID-19* / physiopathology
Female
Humans
Lung* / diagnostic imaging
Lung* / physiopathology
Male
Middle Aged
Risk Factors
SARS-CoV-2 / metabolism*
Tomography, X-Ray Computed*
Vitamin D / analogs & derivatives*
Vitamin D / blood
Vitamin D Deficiency* / blood
Vitamin D Deficiency* / diagnostic imaging
Vitamin D Deficiency* / mortality
Vitamin D Deficiency* / physiopathology

Substances

Vitamin D
25-hydroxyvitamin D