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Abstract
We explored the association between COVID-19 severity and vitamin D status using information from Danish nation-wide health registers, the COVID-19 surveillance database and stored blood samples from the national biobank. 25-hydroxyvitamin D (25(OH)D) was measured using tandem mass spectroscopy. The association between 25(OH)D levels and COVID-19 severity, classified hierarchical as non-hospitalized, hospitalized but not admitted to an intensive care unit (ICU), admitted to ICU, and death, was evaluated by proportional odds ratios (POR) assuming proportionality between the four degrees of severity. Among 447 adults tested SARS-CoV-2 positive in the spring of 2020, low levels of 25(OH)D were associated with a higher risk of severe COVID-19. Thus, odds of experiencing more severe COVID-19 among individuals with insufficient (25 to < 50 nmol/L) and sufficient (≥ 50 nmol/L) 25(OH)D levels were approximately 50% of that among individuals with deficient levels (< 25 nmol/L) (POR = 0.49 (95% CI 0.25–0.94), POR = 0.51 (95% CI 0.27–0.96), respectively). Dividing sufficient vitamin D levels into 50 to < 75 nmol/L and ≥ 75 nmol/L revealed no additional beneficial effect of higher 25(OH)D levels. In this observational study, low levels of 25(OH)D were associated with a higher risk of severe COVID-19. A possible therapeutic role of vitamin D should be evaluated in well-designed interventional studies.
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1 Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark (GRID:grid.6203.7) (ISNI:0000 0004 0417 4147); University of Southern Denmark, Focused Research Unit in Neurology, Department of Neurology, Hospital of Southern Jutland, Aabenraa, Denmark (GRID:grid.10825.3e) (ISNI:0000 0001 0728 0170)
2 Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark (GRID:grid.6203.7) (ISNI:0000 0004 0417 4147)
3 Statens Serum Institut, Section for Clinical Mass Spectrometry, Danish Center for Neonatal Screening, Department of Congenital Disorders, Copenhagen, Denmark (GRID:grid.6203.7) (ISNI:0000 0004 0417 4147); iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark (GRID:grid.452548.a) (ISNI:0000 0000 9817 5300)
4 Statens Serum Institut, Test Center Denmark, Copenhagen, Denmark (GRID:grid.6203.7) (ISNI:0000 0004 0417 4147)
5 Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X)
6 University of Southern Denmark, Focused Research Unit in Neurology, Department of Neurology, Hospital of Southern Jutland, Aabenraa, Denmark (GRID:grid.10825.3e) (ISNI:0000 0001 0728 0170); University of Southern Denmark, Multiple Sclerosis Clinic of Southern Jutland (Sønderborg, Kolding, Esbjerg), Department of Neurology, Hospital of Southern Jutland, Sønderborg, Denmark (GRID:grid.10825.3e) (ISNI:0000 0001 0728 0170)
7 Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X); Brigham and Women’s Hospital and Harvard Medical School, Channing Division of Network Medicine, Boston, USA (GRID:grid.38142.3c) (ISNI:000000041936754X)
8 The Danish National Biobank, Statens Serum Institut, Copenhagen, Denmark (GRID:grid.6203.7) (ISNI:0000 0004 0417 4147)
9 Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark (GRID:grid.6203.7) (ISNI:0000 0004 0417 4147); University of Copenhagen, Pharmacovigilance Research Centre, Department of Drug Design and Pharmacology, Copenhagen, Denmark (GRID:grid.5254.6) (ISNI:0000 0001 0674 042X)