Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results
Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results
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DOI：
10.1001/jamanetworkopen.2020.19722
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发表时间：
2020-09-03
影响因子：
13.8
通讯作者：
Solway, Julian
中科院分区：
文献类型：
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作者：
Meltzer, David O.;Best, Thomas J.;Solway, Julian
这项队列研究旨在探讨患者最近的维生素D水平和维生素D水平不足的治疗是否与2019冠状病毒病（COVID-19）的检测结果相关。问题反映维生素D水平和治疗的维生素D状态与2019冠状病毒病（COVID-19）的检测结果相关吗？在这项对489名在COVID-19检测前一年测量了维生素D水平的患者进行的队列研究中，与维生素D可能充足的患者相比，维生素D可能缺乏的患者COVID-19检测阳性的相对风险高出1. 77倍，差异具有统计学意义。这些发现似乎支持维生素D状态在COVID-19风险中的作用;需要进行随机临床试验，以确定广泛的人群干预以及在维生素D缺乏和COVID-19风险增加的人群中进行干预是否可以降低COVID-19的发病率。重要性已发现维生素D治疗可以降低病毒性呼吸道感染的发病率，尤其是维生素D缺乏的患者。维生素D是否与2019冠状病毒病（COVID-19）发病率有关尚不清楚。目的研究COVID-19检测前最后一次维生素D状态是否与COVID-19检测结果相关。设计、设置和参与者这项在城市学术医疗中心进行的回顾性队列研究纳入了2020年3月3日至4月10日接受COVID-19检测前1年内测量25-羟基胆钙化醇或1，25-二羟基胆钙化醇水平的患者。维生素D缺乏症的定义是在COVID-19检测前最后一次测量25-羟基胆钙化醇低于20 ng/mL或1，25-二羟基胆钙化醇低于18 pg/mL。治疗变化定义为最后一次维生素D水平测量日期与COVID-19检测日期之间维生素D类型和剂量的变化。将维生素D缺乏和治疗变化结合起来，将COVID-19检测前的最新维生素D状态分类为可能缺乏（最后水平缺乏且治疗未增加）、可能充足（最后水平不缺乏且治疗未减少）和2组不确定缺乏（最后水平缺乏且治疗增加，最后水平不缺乏且治疗减少）。主要结局和指标结局为COVID-19聚合酶链反应检测结果阳性。多变量分析测试了COVID-19检测前的维生素D状态是否与COVID-19检测阳性相关，控制了人口统计学和合并症指标。共有489名患者（平均[SD]年龄，49.2 [18.4]岁; 366名[75%]女性; 331名[68%]除白色以外的种族）在COVID-19检测前一年测量了维生素D水平。在COVID-19测试之前，124名参与者（25%）的维生素D状态被归类为可能缺乏，287名（59%）可能足够，78名（16%）不确定。总体而言，71名参与者（15%）的COVID-19检测呈阳性。在多变量分析中，COVID-19检测阳性与年龄增加至50岁相关（相对风险，1.06; 95% CI，1.01-1.09; P = .02）;非白人（相对危险度，2.54; 95% CI，1.26-5.12; P = .009），和可能缺乏维生素D状态（相对危险度，1.77; 95% CI，1.12-2.81; P = 0.02）与可能充足的维生素D状态相比。缺乏组的COVID-19预测发病率为21.6%（95% CI，14.0%-29.2%），充足组为12.2%（95% CI，8.9%-15.4%）。结论和相关性在这项单中心回顾性队列研究中，可能缺乏维生素D状态与COVID-19风险增加相关，这一发现表明可能需要随机试验来确定维生素D是否影响COVID-19风险。
This cohort study examines whether patients' most recent vitamin D levels and treatment for insufficient vitamin D levels are associated with test results for coronavirus disease 2019 (COVID-19).Question Is vitamin D status, reflecting vitamin D levels and treatment, associated with test results for coronavirus disease 2019 (COVID-19)? Findings In this cohort study of 489 patients who had a vitamin D level measured in the year before COVID-19 testing, the relative risk of testing positive for COVID-19 was 1.77 times greater for patients with likely deficient vitamin D status compared with patients with likely sufficient vitamin D status, a difference that was statistically significant. Meaning These findings appear to support a role of vitamin D status in COVID-19 risk; randomized clinical trials are needed to determine whether broad population interventions and interventions among groups at increased risk of vitamin D deficiency and COVID-19 could reduce COVID-19 incidence.Importance Vitamin D treatment has been found to decrease the incidence of viral respiratory tract infection, especially in patients with vitamin D deficiency. Whether vitamin D is associated with coronavirus disease 2019 (COVID-19) incidence is unknown. Objective To examine whether the last vitamin D status before COVID-19 testing is associated with COVID-19 test results. Design, Setting, and Participants This retrospective cohort study at an urban academic medical center included patients with a 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol level measured within 1 year before being tested for COVID-19 from March 3 to April 10, 2020. Exposures Vitamin D deficiency was defined by the last measurement of 25-hydroxycholecalciferol less than 20 ng/mL or 1,25-dihydroxycholecalciferol less than 18 pg/mL before COVID-19 testing. Treatment changes were defined by changes in vitamin D type and dose between the date of the last vitamin D level measurement and the date of COVID-19 testing. Vitamin D deficiency and treatment changes were combined to categorize the most recent vitamin D status before COVID-19 testing as likely deficient (last level deficient and treatment not increased), likely sufficient (last level not deficient and treatment not decreased), and 2 groups with uncertain deficiency (last level deficient and treatment increased, and last level not deficient and treatment decreased). Main Outcomes and Measures The outcome was a positive COVID-19 polymerase chain reaction test result. Multivariable analysis tested whether vitamin D status before COVID-19 testing was associated with testing positive for COVID-19, controlling for demographic and comorbidity indicators. Results A total of 489 patients (mean [SD] age, 49.2 [18.4] years; 366 [75%] women; and 331 [68%] race other than White) had a vitamin D level measured in the year before COVID-19 testing. Vitamin D status before COVID-19 testing was categorized as likely deficient for 124 participants (25%), likely sufficient for 287 (59%), and uncertain for 78 (16%). Overall, 71 participants (15%) tested positive for COVID-19. In multivariate analysis, testing positive for COVID-19 was associated with increasing age up to age 50 years (relative risk, 1.06; 95% CI, 1.01-1.09; P = .02); non-White race (relative risk, 2.54; 95% CI, 1.26-5.12; P = .009), and likely deficient vitamin D status (relative risk, 1.77; 95% CI, 1.12-2.81; P = .02) compared with likely sufficient vitamin D status. Predicted COVID-19 rates in the deficient group were 21.6% (95% CI, 14.0%-29.2%) vs 12.2%(95% CI, 8.9%-15.4%) in the sufficient group. Conclusions and Relevance In this single-center, retrospective cohort study, likely deficient vitamin D status was associated with increased COVID-19 risk, a finding that suggests that randomized trials may be needed to determine whether vitamin D affects COVID-19 risk.