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Article

Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study

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Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy
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Unit of Clinica e Terapia Medica, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, 89124 Reggio Calabria, Italy
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National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy
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CE Medical Writing, 56021 Pisa, Italy
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Internal Medicine, Department of Medicine, University Hospital AOUI, 37134 Verona, Italy
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Laboratory Medicine Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
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Clinica Medica 3, Department of Medicine, University of Padova, 35128 Padova, Italy
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Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy
*
Author to whom correspondence should be addressed.
Nutrients 2021, 13(1), 219; https://doi.org/10.3390/nu13010219
Received: 16 December 2020 / Revised: 10 January 2021 / Accepted: 11 January 2021 / Published: 14 January 2021
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. View Full-Text
Keywords: COVID-19; cholecalciferol; vitamin D; comorbid disease; mortality; intensive care; propensity score COVID-19; cholecalciferol; vitamin D; comorbid disease; mortality; intensive care; propensity score
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MDPI and ACS Style

Giannini, S.; Passeri, G.; Tripepi, G.; Sella, S.; Fusaro, M.; Arcidiacono, G.; Torres, M.O.; Michielin, A.; Prandini, T.; Baffa, V.; Aghi, A.; Egan, C.G.; Brigo, M.; Zaninotto, M.; Plebani, M.; Vettor, R.; Fioretto, P.; Rossini, M.; Vignali, A.; Fabris, F.; Bertoldo, F. Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study. Nutrients 2021, 13, 219. https://doi.org/10.3390/nu13010219

AMA Style

Giannini S, Passeri G, Tripepi G, Sella S, Fusaro M, Arcidiacono G, Torres MO, Michielin A, Prandini T, Baffa V, Aghi A, Egan CG, Brigo M, Zaninotto M, Plebani M, Vettor R, Fioretto P, Rossini M, Vignali A, Fabris F, Bertoldo F. Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study. Nutrients. 2021; 13(1):219. https://doi.org/10.3390/nu13010219

Chicago/Turabian Style

Giannini, Sandro, Giovanni Passeri, Giovanni Tripepi, Stefania Sella, Maria Fusaro, Gaetano Arcidiacono, Marco O. Torres, Alberto Michielin, Tancredi Prandini, Valeria Baffa, Andrea Aghi, Colin G. Egan, Martina Brigo, Martina Zaninotto, Mario Plebani, Roberto Vettor, Paola Fioretto, Maurizio Rossini, Alessandro Vignali, Fabrizio Fabris, and Francesco Bertoldo. 2021. "Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study" Nutrients 13, no. 1: 219. https://doi.org/10.3390/nu13010219

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