PURPOSE To analyze the associations between cholecalciferol or calcifediol supplementation, serum 25-hydroxyvitamin D (25OHD) levels and COVID-19 outcomes in a large population. METHODS All individuals ≥ 18 years old living in Barcelona-Central Catalonia (n = 4.6 million) supplemented with cholecalciferol or calcifediol from April 2019 to February 2020 were compared with propensity score-matched untreated controls. Outcome variables were SARS-CoV2 infection, severe COVID-19 and COVID-19 mortality occuring during the first wave of the pandemic. Demographical data, comorbidities, serum 25OHD levels and concomitant pharmacological treatments were collected as covariates. Associations between cholecalciferol or calcifediol use and outcome variables were analyzed using multivariate Cox proportional regression. RESULTS Cholecalciferol supplementation (n = 108,343) was associated with slight protection from SARS-CoV2 infection (n = 4352 [4.0%] vs 9142/216,686 [4.2%] in controls; HR 0.95 [CI 95% 0.91-0.98], p = 0.004). Patients on cholecalciferol treatment achieving 25OHD levels ≥ 30 ng/ml had lower risk of SARS-CoV2 infection, lower risk of severe COVID-19 and lower COVID-19 mortality than unsupplemented 25OHD-deficient patients (56/9474 [0.6%] vs 96/7616 [1.3%]; HR 0.66 [CI 95% 0.46-0.93], p = 0.018). Calcifediol use (n = 134,703) was not associated with reduced risk of SARS-CoV2 infection or mortality in the whole cohort. However, patients on calcifediol treatment achieving serum 25OHD levels ≥ 30 ng/ml also had lower risk of SARS-CoV2 infection, lower risk of severe COVID-19, and lower COVID-19 mortality compared to 25OHD-deficient patients not receiving vitamin D supplements (88/16276 [0.5%] vs 96/7616 [1.3%]; HR 0.56 [CI 95% 0.42-0.76], p < 0.001). CONCLUSIONS In this large, population-based study, we observed that patients supplemented with cholecalciferol or calcifediol achieving serum 25OHD levels ≥ 30 ng/ml were associated with better COVID-19 outcomes.

中文翻译：

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维生素 D 补充剂和 COVID-19 风险：一项基于人群的队列研究。


目的 分析大量人群中补充胆钙化醇或骨化二醇、血清 25-羟基维生素 D (25OHD) 水平与 COVID-19 结局之间的关联。方法 将 2019 年 4 月至 2020 年 2 月期间居住在巴塞罗那-加泰罗尼亚中部的所有 ≥ 18 岁的个体（n = 460 万）与倾向评分匹配的未治疗对照进行比较，这些个体补充了胆骨化醇或骨化二醇。结果变量是第一波大流行期间发生的 SARS-CoV2 感染、严重的 COVID-19 和 COVID-19 死亡率。收集人口统计数据、合并症、血清 25OHD 水平和伴随的药物治疗作为协变量。使用多元 Cox 比例回归分析胆钙化醇或骨化二醇的使用与结果变量之间的关联。结果 补充胆钙化醇 (n = 108,343) 与 SARS-CoV2 感染有轻微保护作用（对照组 n = 4352 [4.0%] vs 9142/216,686 [4.2%]；HR 0.95 [CI 95% 0.91-0.98]，p = 0.004）。与未补充 25OHD 缺乏的患者相比，接受胆钙化醇治疗且 25OHD 水平≥ 30 ng/ml 的患者感染 SARS-CoV2 的风险较低，患严重 COVID-19 的风险较低，并且 COVID-19 死亡率较低（56/9474 [0.6%] vs 96） /7616 [1.3%]；HR 0.66 [CI 95% 0.46-0.93]，p = 0.018）。在整个队列中，骨化二醇的使用（n = 134,703）与 SARS-CoV2 感染或死亡率风险降低无关。然而，与未接受维生素 D 补充剂的 25OHD 缺乏患者相比，接受骨化二醇治疗且血清 25OHD 水平≥ 30 ng/ml 的患者感染 SARS-CoV2 的风险也较低，患重症 COVID-19 的风险也较低，并且 COVID-19 死亡率也较低（88/16276 [0.5%] 对比 96/7616 [1.3%]；HR 0.56 [CI 95% 0.42-0.76]，p < 0.001）。 结论 在这项基于人群的大型研究中，我们观察到补充胆骨化醇或骨化二醇的患者血清 25OHD 水平≥ 30 ng/ml 与更好的 COVID-19 结局相关。