Prognostic implications of vitamin D in patients with COVID-19
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LETTER TO THE EDITOR
Prognostic implications of vitamin D in patients with COVID‑19 Tom Hosack1 · Vadir Baktash1 · Amit K. J. Mandal1 · Constantinos G. Missouris1,2
© Springer-Verlag GmbH Germany, part of Springer Nature 2020
To The Editor, We congratulate Hastie et al. on their short communication [1]. Their study was published soon after the recent rapid evidence review by The National Institute for Health and Clinical Excellence (NICE) [2], supporting the conclusion that there is no substantial evidence to date of an association between vitamin D deficiency and severity of or mortality from COVID-19. We would like to take this opportunity to report our experience which identified contrasting conclusions to the above. We recently conducted a prospective cohort study in the United Kingdom (UK) to assess the role of serum vitamin D (25-OH-D) levels in older patients with COVID-19 [3]. Importantly, our study showed that patients with low concentrations of 25OH-D (≤ 30 nmol/L) demonstrated clinically significant, elevated markers of cytokine storm resulting in critical hypoxia requiring non-invasive ventilatory support. Although our study was underpowered to detect a significant mortality difference between the vitamin D deficient and replete groups, our findings support that Vitamin D status may be a surrogate prognosticator for morbidity and mortality in patients with COVID-19. There are a few possibilities as to why our results differed from that of Hastie and colleagues. Unlike our study, Hastie et al. obtained a large study sample using historical data from the UK biobank database. Considering evidence of vitamin D possibly being a negative acute phase A reply to this letter can be read here: doi:https://doi.org/10.1007/ s00394-020-02430-x. This letter refers to the original publication available here: doi:https://doi.org/10.1007/s00394-020-02372-4. * Constantinos G. Missouris [email protected] 1
Departments of Cardiology and Internal Medicine, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Wexham Street, Slough, UK
University of Cyprus Medical School, Nicosia, Cyprus
2
reactant [4, 5], historical data may have been used to help avert from bias secondary to reverse causality. Nonetheless, using historical data from 10 years ago remains a significant limitation to the study. The authors justify this by identifying a subgroup of 15,473 patients that remained vitamin D deficient at follow-up on average 4.3 years later and would therefore have likely remained deficient during the COVID19 pandemic. The major drawback to this inference is the launch of new guidelines on vitamin D supplementation by the National Health Service (NHS) in the UK in July 2016, recommending that everyone should take vitamin D supplementation during winter months [3]. This national effort to tackle long-term mineral and bone disorders after the study’s follow-up period is likely to have introduced significant variability in vitamin D statuses of their study population. Multivariate analyses were undertake
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