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4th March 2022
The use of a large oral bolus of cholecalciferol (vitamin D) given to patients with moderate-to-severe COVID-19 upon admission to a hospital failed to improve overall outcomes compared with no treatment.
This was the conclusion of a large, randomised trial by researchers from the Hospital Universitario Central de Asturias (HUCA), Avda. Roma, Spain. However, in a separate subgroup analysis, it did appear that there were positive benefits among those with higher baseline calcidiol levels upon admission.
An inverse relationship has been established between vitamin D levels and the development of several autoimmune diseases although whether this effect on the immune system has a positive impact upon the body’s ability to fight respiratory infections and on chronic diseases is currently uncertain.
Much has been written on the potential benefits of vitamin D among patients with COVID-19 and one systematic review concluded that low vitamin D levels represent an increased risk of acute respiratory distress syndrome, admission to an intensive care unit or mortality due to COVID-19 infection.
Nevertheless, a limitation from the aforementioned systematic review, it how the data were derived from observational studies and there has been a distinct absence of randomised, controlled trials, which can provide more robust evidence.
For the present study, the Spanish team undertook a randomised trial (COVID-VIT-D) to investigate whether a single, large, oral bolus of 100,000 IU of cholecalciferol given upon admission to hospital, could impact on the outcomes associated with a COVID-19 infection.
Eligible patients (18 years and over) were those hospitalised for moderate-to-severe COVID-19 infection and who were randomised 1:1, to receive a single oral bolus of cholecalciferol or nothing. Patients were followed from admission until discharge and demographic, co-morbidity, biochemical, imaging results and all treatments used were recorded.
The three primary outcomes for the trial were: length of hospitalisation; admission to an intensive care unit (ICU) and mortality. In a separate cohort analysis, the researchers examined the relationship between serum calcidiol upon admission with pulmonary involvement and the same three primary outcomes of the trial.
Single oral bolus and COVID-19 outcomes
A total of 543 patients with a median age of 58 years (65% male) were randomised to vitamin D (274) or nothing. The most frequent co-morbidities were hypertension (43.8%), diabetes (24.7%) and cardiovascular disease (21.2%). In addition, pulmonary involvement was diagnosed in 83.1% of those upon admission.
With respect to the primary outcomes, there were no differences between the two groups. The median length of hospital stay was 10 vs 9.5 days (vitamin D vs control), admission to ICU (172.% vs 16.4%) and mortality (8% vs 5.6%).
When considering the lowest (< 10ng/ml) and highest(> 25 ng/ml) baseline levels, the presence of a higher calcidiol level was associated with a lower risk of pulmonary involvement upon admission (odds ratio, OR = 0.21, 95% CI 0.08 – 0.60) and a lower risk of ICU admission (hazard ratio, HR = 0.35, 95% CI 0.13 – 0.95). However, baseline calcidiol levels had no effect on the length of hospitalisation or mortality.
The authors concluded that while a single oral bolus of vitamin D did not improve overall outcomes for those hospitalised with COVID-19, higher baseline calcidiol levels did appear to have better outcomes.
Cannata‐Andía JB et al. A single-oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve outcomes in the COVID-19 disease: the COVID-VIT-D—a randomised multicentre international clinical trial BMC Med 20222