The Interaction of Vitamin D and Corticosteroids: A Mortality Analysis of 26,508 Veterans Who Tested Positive for SARS-CoV-2
Jimmy T Efird, Ethan J Anderson, Charulata Jindal, Thomas S Redding, Andrew D Thompson, Ashlyn M Press, Julie Upchurch, Christina D Williams, Yuk Ming Choi, Ayako Suzuki
International Journal of Environmental Research and Public Health, doi:10.3390/ijerph19010447
This data-based cohort consisted of 26,508 (7%) United States veterans out of the 399,290 who tested positive for SARS-CoV-2 from 1 March to 10 September 2020. We aimed to assess the interaction of post-index vitamin D (Vit D) and corticosteroid (CRT) use on 30-day mortality among hospitalized and non-hospitalized patients with coronavirus disease 2019 (COVID-19). Combination Vit D and CRT drug use was assessed according to four multinomial pairs (−|+, −|−, +|+, +|−). Respective categorical effects were computed on a log-binomial scale as adjusted relative risk (aRR). Approximately 6% of veterans who tested positive for SARS-CoV-2 died within 30 days of their index date. Among hospitalized patients, a significantly decreased aRR was observed for the use of Vit D in the absence of CRTs relative to patients who received CRTs but not Vit D (aRR = 0.30; multiplicity corrected, p = 0.0004). Among patients receiving systemically administered CRTs (e.g., dexamethasone), the use of Vit D was associated with fewer deaths in hospitalized patients (aRR = 0.51) compared with non-hospitalized patients (aRR = 2.5) (P-for-Interaction = 0.0071). Evaluating the effect of modification of these compounds in the context of hospitalization may aid in the management of COVID-19 and provide a better understanding of the pathophysiological mechanisms underlying this and future infectious disease outbreaks.
Author Contributions: Conceptualization, J.T.E., A.S. and E.J.A.; data curation, T.S.R., A.D.T. and J.T.E.; formal analysis, J.T.E., T.S.R. and A.D.T.; funding acquisition, A.S.; methodology, J.T.E.; project administration, A.S., A.M.P. and J.U.; supervision, A.S. and J.T.E.; validation, A.D.T.; visualization,
Conflicts of Interest: The authors declare no conflict of interest.
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