Real world evidence of calcifediol or vitamin D prescription and mortality rate of COVID-19 in a retrospective cohort of hospitalized Andalusian patients

Carlos Loucera, María Peña-Chilet, Marina Esteban-Medina, Dolores Muñoyerro-Muñiz, Román Villegas, Jose Lopez-Miranda, Jesus Rodriguez-Baño, Isaac Túnez, Roger Bouillon, Joaquin Dopazo, Jose Manuel Quesada Gomez, Carlos Loucera, María Peña-Chilet, Marina Esteban-Medina, Dolores Muñoyerro-Muñiz, Román Villegas, Jose Lopez-Miranda, Jesus Rodriguez-Baño, Isaac Túnez, Roger Bouillon, Joaquin Dopazo, Jose Manuel Quesada Gomez

Abstract

COVID-19 is a major worldwide health problem because of acute respiratory distress syndrome, and mortality. Several lines of evidence have suggested a relationship between the vitamin D endocrine system and severity of COVID-19. We present a survival study on a retrospective cohort of 15,968 patients, comprising all COVID-19 patients hospitalized in Andalusia between January and November 2020. Based on a central registry of electronic health records (the Andalusian Population Health Database, BPS), prescription of vitamin D or its metabolites within 15-30 days before hospitalization were recorded. The effect of prescription of vitamin D (metabolites) for other indication previous to the hospitalization was studied with respect to patient survival. Kaplan-Meier survival curves and hazard ratios support an association between prescription of these metabolites and patient survival. Such association was stronger for calcifediol (Hazard Ratio, HR = 0.67, with 95% confidence interval, CI, of [0.50-0.91]) than for cholecalciferol (HR = 0.75, with 95% CI of [0.61-0.91]), when prescribed 15 days prior hospitalization. Although the relation is maintained, there is a general decrease of this effect when a longer period of 30 days prior hospitalization is considered (calcifediol HR = 0.73, with 95% CI [0.57-0.95] and cholecalciferol HR = 0.88, with 95% CI [0.75, 1.03]), suggesting that association was stronger when the prescription was closer to the hospitalization.

Conflict of interest statement

RB declares payment of honoraria for lectures by FAES (Spain), Abiogen (Italy) and Fresenius (Germany). JMQ declares small consulting fees and small lecture fees from Amgen and FESE Farma (Spain). The rest of authors declare no competing interests.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
Kaplan–Meier curves of patients who received a prescription for ADM (A) 15 days and (B) 30 days before hospitalization for death outcome.
Figure 2
Figure 2
Hazard ratios with respect to the outcome death under ATT assumption for the cholecalciferol, calcifediol and ADM prescription in the two periods considered (15 and 30 days before hospitalization). In all the cases (except for cholecalciferol at 30 days) a significant association between prescription of these metabolites and patient survival is observed: confidence intervals do not cross the 1 line (α = 0.05).

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