The link between COVID-19 and VItamin D (VIVID): A systematic review and meta-analysis.
The link between COVID-19 and VItamin D (VIVID): A systematic review and meta-analysis.
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DOI：
10.1016/j.metabol.2021.154753
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
El-Hajj Fuleihan G
中科院分区：
文献类型：
--
作者：
Bassatne A;Basbous M;Chakhtoura M;El Zein O;Rahme M;El-Hajj Fuleihan G
老年人和慢性病患者是维生素 D 缺乏的高风险人群，因感染 COVID-19 导致的疾病严重程度和死亡率更高。维生素 D 在免疫功能和炎症中发挥着重要作用。这项系统回顾和荟萃分析评估了维生素 D 状态和补充对 COVID-19 相关死亡率和健康结果的影响。我们检索了四个数据库，截止日期为 2020 年 12 月 18 日，试验注册截止日期为 2021 年 1 月 20 日。两名评审员独立且一式两份地筛选研究、收集数据、评估偏倚风险并对每个研究结果的证据进行分级。预先指定的关注结果包括死亡率、入住 ICU、有创和无创通气、住院、住院时间、疾病严重程度和 SARS-CoV-2 阳性。我们的初步分析中仅包含来自同行评审文章的数据。我们确定了 31 项经过同行评审的观察性研究。在我们的初步分析中，血清 25(OH)D 水平<20ng/ml 与死亡、入住 ICU、有创通气、无创通气或 SARS-CoV-2 阳性风险增加之间存在积极趋势。然而，这些关联并不具有统计学意义。与阴性患者相比，COVID-19 阳性患者的平均 25(OH)D 水平为 5.9ng/ml (95% CI [−9.5, −2.3])，显着较低。证据的质量非常低。我们确定了 32 项临床试验方案，但迄今为止只有 3 项公布了结果。这些试验的维生素 D 剂量为每天 357 至 60,000IU，持续 1 周至 12 个月。八项大型试验调查了维生素 D 对门诊患者的功效。一项试点试验显示，与安慰剂相比，骨化二醇组入住 ICU 的人数显着减少 (OR=0.003)，但证据的确定性尚不清楚。另一项小型试验表明，与安慰剂相比，每天补充 60,000IU 胆钙化醇可降低纤维蛋白原水平，但对 D-二聚体、降钙素原和 CRP 水平没有影响。第三项试验未发现维生素 D 补充剂对 COVID-19 相关健康结果有任何影响。虽然迄今为止的现有证据（大部分来自质量较差的观察性研究）可能被视为显示低血清 25(OH)D 水平与 COVID-19 相关健康结果之间存在关联的趋势，但这种关系并未发现具有统计显着性。补充骨化二醇可能对 COVID-19 相关 ICU 入院有保护作用。目前在 COVID-19 患者中使用高剂量维生素 D 并没有确凿的证据。它正在等待正在进行的试验的结果，以确定维生素 D 补充剂预防和治疗 COVID-19 相关健康结果的功效、理想剂量和安全性。
Disease severity and mortality rates due to COVID-19 infection are greater in the elderly and chronically ill patients, populations at high risk for vitamin D deficiency. Vitamin D plays an important role in immune function and inflammation. This systematic review and meta-analysis assesses the impact of vitamin D status and supplementation on COVID-19 related mortality and health outcomes. We searched four databases until December 18th 2020, and trial registries until January 20th 2021. Two reviewers screened the studies, collected data, assessed the risk of bias, and graded the evidence for each outcome across studies, independently and in duplicate. Pre-specified outcomes of interest were mortality, ICU admission, invasive and non-invasive ventilation, hospitalization, time of hospital stay, disease severity and SARS-CoV-2 positivity. We only included data from peer-reviewed articles in our primary analyses. We identified 31 peer-reviewed observational studies. In our primary analysis, there was a positive trend between serum 25(OH)D level <20 ng/ml and an increased risk of mortality, ICU admission, invasive ventilation, non-invasive ventilation or SARS-CoV-2 positivity. However, these associations were not statistically significant. Mean 25(OH)D levels was 5.9 ng/ml (95% CI [−9.5, −2.3]) significantly lower in COVID-19 positive, compared to negative patients. The certainty of the evidence was very low. We identified 32 clinical trial protocols, but only three have published results to-date. The trials administer vitamin D doses of 357 to 60,000 IU/day, from one week to 12 months. Eight megatrials investigate the efficacy of vitamin D in outpatient populations. A pilot trial revealed a significant decrease in ICU admission with calcifediol, compared to placebo (OR = 0.003), but the certainty of the evidence was unclear. Another small trial showed that supplementation with cholecalciferol, 60,000 IU/day, decreased fibrinogen levels, but did not have an effect on D-dimer, procalcitonin and CRP levels, compared to placebo. The third trial did not find any effect of vitamin D supplementation on COVID-19 related health outcomes. While the available evidence to-date, from largely poor-quality observational studies, may be viewed as showing a trend for an association between low serum 25(OH)D levels and COVID-19 related health outcomes, this relationship was not found to be statistically significant. Calcifediol supplementation may have a protective effect on COVID-19 related ICU admissions. The current use of high doses of vitamin D in COVID-19 patients is not based on solid evidence. It awaits results from ongoing trials to determine the efficacy, desirable doses, and safety, of vitamin D supplementation to prevent and treat COVID-19 related health outcomes.
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影响因子：
3.7
作者：
PLOS ONE Editors
通讯作者：
PLOS ONE Editors
影响因子：
20.3
作者：
Bouillon R;Marcocci C;Carmeliet G;Bikle D;White JH;Dawson-Hughes B;Lips P;Munns CF;Lazaretti-Castro M;Giustina A;Bilezikian J
通讯作者：
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影响因子：
9.8
作者：
Chakhtoura, M.;Napoli, N.;Fuleihan, G. El Hajj
通讯作者：
Fuleihan, G. El Hajj
影响因子：
5.9
作者：
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通讯作者：
Heijboer AC
影响因子：
5.9
作者：
Grant WB;Lahore H;Rockwell MS
通讯作者：
Rockwell MS