Prognostic and Therapeutic Role of Vitamin D in COVID-19: Systematic Review and Meta-analysis
Dissanayake HA, de Silva NL, Sumanatilleke M, de Silva SDN, Gamage KKK, Dematapitiya C, Kuruppu DC, Ranasinghe P, Pathmanathan S, Katulanda P
The Journal of clinical endocrinology and metabolism · 92 citas
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2021-12-11 · J Clin Endocrinol Metab · vol. 107 · número 5 · págs. 1484–1502
- Editorial
- Oxford University Press
- Citado
- 129 citas · más que el 99% de estudios similares · 6.9× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 108 trabajos
- Acceso
- Acceso abierto (copia en repositorio)
- Áreas de investigación
- Vitamin D Research Studies · COVID-19 Clinical Research Studies · SARS-CoV-2 and COVID-19 Research
- Palabras clave
- vitamin D deficiency, vitamin D insufficiency, COVID-19 pandemic, SARS-CoV-2, COVID-19 susceptibility, disease severity, mortality, 25-hydroxyvitamin D, vitamin D supplementation
- MeSH
- humans, vitamin d deficiency, vitamins, vitamin d, prognosis, adult, covid-19
10 autores
- Harsha Anuruddhika Dissanayake🇱🇰 · autor de correspondenciaUniversity of Colombo
- Nipun Lakshitha de Silva🇱🇰General Sir John Kotelawala Defence University
- Manilka Sumanatilleke🇱🇰National Hospital of Sri Lanka
- Sawanawadu Dilantha Neomal de Silva🇱🇰National Hospital of Sri Lanka
- Kavinga Kalhari Kobawaka Gamage🇱🇰National Hospital of Sri Lanka
- Chinthana Dematapitiya🇱🇰National Hospital of Sri Lanka
- Chandrani Kuruppu🇱🇰University of Colombo
- Priyanga Diloshini Ranasinghe🇱🇰University of Colombo
- Sivatharshya Pathmanathan🇱🇰National Hospital of Sri Lanka
- Prasad Katulanda🇬🇧🇱🇰University of Oxford; University of Colombo
Resumen
El texto original del estudio, en el idioma en que se publicó.
Purpose
Vitamin D deficiency/insufficiency may increase the susceptibility to coronavirus disease 2019 (COVID-19). We aimed to determine the association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, its severity, mortality, and role of vitamin D in its treatment.
Methods
We searched CINAHL, Cochrane library, EMBASE, PubMED, Scopus, and Web of Science up to May 30, 2021, for observational studies on association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, severe disease, and death among adults, and, randomized controlled trials (RCTs) comparing vitamin D treatment against standard care or placebo, in improving severity or mortality among adults with COVID-19. Risk of bias was assessed using Newcastle-Ottawa scale for observational studies and AUB-KQ1 Cochrane tool for RCTs. Study-level data were analyzed using RevMan 5.3 and R (v4.1.0). Heterogeneity was determined by I2 and sources were explored through prespecified sensitivity analyses, subgroup analyses, and meta-regressions.
Results
Of 1877 search results, 76 studies satisfying eligibility criteria were included. Seventy-two observational studies were included in the meta-analysis (n = 1 976 099). Vitamin D deficiency/insufficiency increased the odds of developing COVID-19 (odds ratio [OR] 1.46; 95% CI, 1.28-1.65; P < 0.0001; I2 = 92%), severe disease (OR 1.90; 95% CI, 1.52-2.38; P < 0.0001; I2 = 81%), and death (OR 2.07; 95% CI, 1.28-3.35; P = 0.003; I2 = 73%). The 25-hydroxy vitamin D concentrations were lower in individuals with COVID-19 compared with controls (mean difference [MD] -3.85 ng/mL; 95% CI, -5.44 to -2.26; P ≤ 0.0001), in patients with severe COVID-19 compared with controls with nonsevere COVID-19 (MD -4.84 ng/mL; 95% CI, -7.32 to -2.35; P = 0.0001) and in nonsurvivors compared with survivors (MD -4.80 ng/mL; 95% CI, -7.89 to -1.71; P = 0.002). The association between vitamin D deficiency/insufficiency and death was insignificant when studies with high risk of bias or studies reporting unadjusted effect estimates were excluded. Risk of bias and heterogeneity were high across all analyses. Discrepancies in timing of vitamin D testing, definitions of severe COVID-19, and vitamin D deficiency/insufficiency partly explained the heterogeneity. Four RCTs were widely heterogeneous precluding meta-analysis.
Conclusion
Multiple observational studies involving nearly 2 million adults suggest vitamin D deficiency/insufficiency increases susceptibility to COVID-19 and severe COVID-19, although with a high risk of bias and heterogeneity. Association with mortality was less robust. Heterogeneity in RCTs precluded their meta-analysis.
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