VITAMIN D3 RESEARCH - Calcifediol treatment and COVID-19-related outcomes | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic

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Accepted manuscript

Xavier Nogues ,

IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)

, Barcelona,

Spain

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona

, Barcelona,

Spain

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Diana Ovejero ,

IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)

, Barcelona,

Spain

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona

, Barcelona,

Spain

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Marta Pineda-Moncusí ,

IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)

, Barcelona,

Spain

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Roger Bouillon ,

Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven

, Herestraat, Leuven,

Belgium

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Dolors Arenas ,

Department of Nephrology, Hospital del Mar-IMIM

, Barcelona,

Spain

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Julio Pascual ,

Department of Nephrology, Hospital del Mar-IMIM

, Barcelona,

Spain

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Anna Ribes ,

IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)

, Barcelona,

Spain

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Robert Guerri-Fernandez ,

IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)

, Barcelona,

Spain

Department of Infectious Diseases, Hospital del Mar-IMIM

, Barcelona,

Spain

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Judit Villar-Garcia ,

Department of Infectious Diseases, Hospital del Mar-IMIM

, Barcelona,

Spain

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Abora Rial ,

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona

, Barcelona,

Spain

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... Show more Carme Gimenez-Argente ,

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona

, Barcelona,

Spain

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Maria Lourdes Cos ,

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona

, Barcelona,

Spain

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Jaime Rodriguez-Morera ,

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona

, Barcelona,

Spain

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Isabel Campodarve ,

Internal Medicine Department, Hospital del Mar, Universitat Autònoma de Barcelona

, Barcelona,

Spain

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José Manuel Quesada-Gomez ,

José Manuel Quesada-Gomez

Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC). Fundación Progreso y Salud. CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES). Hospital Universitario Reina Sofía. Universidad de Córdoba. Menéndez Pidal s/n

, Córdoba,

Spain

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Natalia Garcia-Giralt

IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES)

, Barcelona,

Spain

Corresponding author: Natalia Garcia-Giralt, PhD, Postdoc Researcher in CIBER in frailty and healthy ageing, Associate Lecturer of University of Barcelona, e-mail:

ngarcia@imim.es

, ORCID: 0000-0001-6507-0147

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Abstract

Context

COVID-19 is a major health problem because of saturation of intensive care units (ICU) and mortality. Vitamin D has emerged as a potential treatment able to reduce the disease severity.

Objective

To elucidate the effect of calcifediol [25OHD3] treatment on COVID-19-related outcomes.

Design

Observational cohort study from March to May, 2020.

Setting

Patients admitted to COVID-19 wards of Hospital del Mar, Barcelona, Spain.

Patients

A total of 930 patients with COVID-19 were included. Ninety-two were excluded due to previous calcifediol intake.

Intervention

Of the remaining 838, a total of 447 received calcifediol (532ug on day one plus 266ug on day 3, 7, 15, and 30) whereas 391 were not treated at the time of hospital admission (Intention-to-Treat). Of the latter, 53 patients were treated later during ICU admission and were allocated in the treated group in a second analysis. In healthy subjects, calcifediol is about 3.2-fold more potent on a weight basis than cholecalciferol.

Main Outcome Measures

ICU admission and mortality.

Results

ICU assistance was required by 102 (12.2%) participants. Out of 447 patients treated with calcifediol at admission, 20 (4.5%) required ICU, compared to 82 (21%) out of 391 non-treated (p-value<0.0001). Logistic regression of calcifediol treatment on ICU admission, adjusted by age, gender, linearized 25OHD levels at baseline, and comorbidities showed that treated patients had a reduced risk to require ICU (OR 0.13 [95% CI 0.07;0.23]). Overall mortality was 10%. In the Intention-to-Treat analysis, 21 (4.7%) out of 447 patients treated with calcifediol at admission died compared to 62 patients (15.9%) out of 391 non-treated (p=0.0001). Adjusted results showed a reduced mortality risk with an OR 0.21 [95% CI 0.10; 0.43]). In the second analysis, the obtained OR was 0.52 [95% CI 0.27;0.99].

Conclusions

In patients hospitalized with COVID-19, calcifediol treatment significantly reduced ICU admission and mortality.

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Author notes

Both authors contributed equally to this work

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https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgab405/6294179