Vitamin D and survival in COVID-19 patients: A quasi-experimental study.
Vitamin D and survival in COVID-19 patients: A quasi-experimental study.
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DOI：
10.1016/j.jsbmb.2020.105771
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发表时间：
2020-11
期刊：
影响因子：
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通讯作者：
Célarier T
中科院分区：
文献类型：
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作者：
Annweiler C;Hanotte B;Grandin de l'Eprevier C;Sabatier JM;Lafaie L;Célarier T
维生素D可能是新冠肺炎预后的一个核心生物学决定因素。在新冠肺炎期间或之前补充维生素D3与虚弱老年人新冠肺炎程度较轻相关。在新冠肺炎期间或之前补充维生素D3与虚弱老年人更好的存活率相关。随机对照试验有望得出补充维生素D对新冠肺炎预后影响的确切结论。维生素D可能是新冠肺炎预后的一个核心生物学决定因素。这项准实验研究的目的是确定在新冠肺炎期间或之前补充维生素D3对改善患有新冠肺炎的虚弱养老院居民的存活率是否有效。66名来自法国养老院的新冠肺炎患者被纳入这项准实验性研究。“干预组”被定义为在新冠肺炎期间或前一个月接受维生素D3补充团剂的人，而“对照组”与所有其他参与者通信。主要和次要结果分别为急性期新冠肺炎病死率和临床改善序贯量表评分。年龄、性别、每日用药次数、功能能力、白蛋白血症、皮质类固醇和/或羟氯喹和/或抗生素(即阿奇霉素或罗维霉素)的使用和新冠肺炎的住院是潜在的混杂因素。干预组(n=57；平均±SD，87.7±9.3岁；女性79%)和对照组(n=9；平均，87.4±7.2岁；67%女性)在基线上相似，新冠肺炎的严重程度和专用新冠肺炎药物的使用也是相似的。平均随访时间(36±17)d。干预组82.5%的参与者存活在新冠肺炎中，而对照组仅为44.4%(P=0.023)。根据补充维生素D3，死亡率的完全调整风险比为HR=0.11[95%CI：0.03；0.48]，P=0.003。Kaplan-Meier分布显示干预组的生存时间明显长于对照组(对数等级P=0.002)。最后，补充维生素D3与新冠肺炎的OSCI评分呈负相关(β=-3.84[95%CI：-6.07；-1.62]，P=0.001)。总而言之，在新冠肺炎期间或之前补充维生素D3与新冠肺炎程度较轻、存活率较高的虚弱老年人相关。
Vitamin D may be a central biological determinant of COVID-19 outcomes. Bolus vitamin D3 supplementation during or just before COVID-19 was associated with less severe COVID-19 in frail elderly. Bolus vitamin D3 supplementation during or just before COVID-19 was associated with better survival rate in frail elderly. Randomized controlled trials are expected to firmly conclude the effect of vitamin D supplementation on COVID-19 prognosis. Vitamin D may be a central biological determinant of COVID-19 outcomes. The objective of this quasi-experimental study was to determine whether bolus vitamin D3 supplementation taken during or just before COVID-19 was effective in improving survival among frail elderly nursing-home residents with COVID-19. Sixty-six residents with COVID-19 from a French nursing-home were included in this quasi-experimental study. The “Intervention group” was defined as those having received bolus vitamin D3 supplementation during COVID-19 or in the preceding month, and the “Comparator group” corresponded to all other participants. The primary and secondary outcomes were COVID-19 mortality and Ordinal Scale for Clinical Improvement (OSCI) score in acute phase, respectively. Age, gender, number of drugs daily taken, functional abilities, albuminemia, use of corticosteroids and/or hydroxychloroquine and/or antibiotics (i.e., azithromycin or rovamycin), and hospitalization for COVID-19 were used as potential confounders. The Intervention (n = 57; mean ± SD, 87.7 ± 9.3years; 79 %women) and Comparator (n = 9; mean, 87.4 ± 7.2years; 67 %women) groups were comparable at baseline, as were the COVID-19 severity and the use of dedicated COVID-19 drugs. The mean follow-up time was 36 ± 17 days. 82.5 % of participants in the Intervention group survived COVID-19, compared to only 44.4 % in the Comparator group (P = 0.023). The full-adjusted hazard ratio for mortality according to vitamin D3 supplementation was HR = 0.11 [95 %CI:0.03;0.48], P = 0.003. Kaplan-Meier distributions showed that Intervention group had longer survival time than Comparator group (log-rank P = 0.002). Finally, vitamin D3 supplementation was inversely associated with OSCI score for COVID-19 (β=-3.84 [95 %CI:-6.07;-1.62], P = 0.001). In conclusion, bolus vitamin D3 supplementation during or just before COVID-19 was associated in frail elderly with less severe COVID-19 and better survival rate.