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Article

The Relationship Between the Severity and Mortality of SARS-CoV-2 Infection and 25-hydroxyvitamin D Concentration—A Metaanalysis

1
Drug Safety Research Center, Facultad de Medicina Humana, Universidad de San Martín de Porres, Hospital Almenara,ESSALUD, Lima, Peru
2
Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
3
Clinical Pharmacology Department, Vall d’Hebron Hospital, Barcelona, Spain
4
The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland
5
Academic Unit of Anaesthesia, College of Medical, Veterinary and Life of Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
6
Discipline of Medical Gerontology, Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
7
Global Brain Health Institute, Trinity College Dublin, Ireland
*
Author to whom correspondence should be addressed.
Adv. Respir. Med. 2021, 89(2), 145-157; https://doi.org/10.5603/ARM.a2021.0037
Submission received: 14 December 2020 / Revised: 4 February 2021 / Accepted: 4 February 2021 / Published: 22 April 2021

Abstract

Introduction: There is increasing scientific interest in the possible association between hypovitaminosis D and the risk of SARS-CoV-2 infection severity and/or mortality. Objective: To conduct a metanalysis of the association between 25-hydroxyvitamin D (25(OH)D) concentration and SARS-CoV-2 infection severity or mortality. Material and methods: We searched PubMed, EMBASE, Google scholar and the Cochrane Database of Systematic Reviews for studies published between December 2019 and December 2020. Effect statistics were pooled using random effects models. The quality of included studies was assessed with the Newcastle–Ottawa Scale (NOS). Targeted outcomes: mortality and severity proportions in COVID-19 patients with 25(OH)D deficiency, defined as serum 25(OH)D < 50 nmol/L. Results: In the 23 studies included (n = 2692), the mean age was 60.8 (SD ± 15.9) years and 53.8% were men. Results suggested that vitamin 25(OH)D deficiency was associated with increased risk of severe SARS-CoV-2 disease (RR 2.00; 95% CI 1.47–2.71, 17 studies) and mortality (RR 2.45; 95% CI 1.24–4.84, 13 studies). Only 7/23 studies reported C-reactive protein values, all of which were > 10 mg/L. Conclusions: 25(OH)D deficiency seems associated with increased SARS-CoV-2 infection severity and mortality. However, findings do not imply causality, and randomized controlled trials are required, and new studies should be designed to determine if decreased 25(OH)D is an epiphenomenon or consequence of the inflammatory process associated with severe forms of SARS-CoV-2. Meanwhile, the concentration of 25(OH)D could be considered as a negative acute phase reactant and a poor prognosis in COVID-19 infection.
Keywords: SARS-CoV-2; COVID-19; vitamin D; 25-hydroxyvitamin D; severity SARS-CoV-2; COVID-19; vitamin D; 25-hydroxyvitamin D; severity

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MDPI and ACS Style

Oscanoa, T.J.; Amado, J.; Vidal, X.; Laird, E.; Ghashut, R.A.; Romero-Ortuno, R. The Relationship Between the Severity and Mortality of SARS-CoV-2 Infection and 25-hydroxyvitamin D Concentration—A Metaanalysis. Adv. Respir. Med. 2021, 89, 145-157. https://doi.org/10.5603/ARM.a2021.0037

AMA Style

Oscanoa TJ, Amado J, Vidal X, Laird E, Ghashut RA, Romero-Ortuno R. The Relationship Between the Severity and Mortality of SARS-CoV-2 Infection and 25-hydroxyvitamin D Concentration—A Metaanalysis. Advances in Respiratory Medicine. 2021; 89(2):145-157. https://doi.org/10.5603/ARM.a2021.0037

Chicago/Turabian Style

Oscanoa, Teodoro J, Jose Amado, Xavier Vidal, Eamon Laird, Rawia A Ghashut, and Roman Romero-Ortuno. 2021. "The Relationship Between the Severity and Mortality of SARS-CoV-2 Infection and 25-hydroxyvitamin D Concentration—A Metaanalysis" Advances in Respiratory Medicine 89, no. 2: 145-157. https://doi.org/10.5603/ARM.a2021.0037

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