Vitamin D supplementation and clinical outcomes in COVID-19: a systematic review and meta-analysis
R Pal, M Banerjee, S K Bhadada, A J Shetty, B Singh, A Vyas
Journal of Endocrinological Investigation, doi:10.1007/s40618-021-01614-4
Purpose To provide a precise summary and collate the hitherto available clinical evidence on the effect of vitamin D supplementation on clinical outcomes in COVID-19 patients. Methods PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched using appropriate keywords till June 8, 2021, to identify observational studies and randomized controlled trials (RCTs) reporting adverse clinical outcomes (ICU admission and/or mortality) in COVID-19 patients receiving vitamin D supplementation vs. those not receiving the same. Both prior use and use of vitamin D after COVID-19 diagnosis were considered. Unadjusted/adjusted pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated (PROSPERO registration number CRD42021248488).
Results We identified 13 studies (10 observational, 3 RCTs) pooling data retrieved from 2933 COVID-19 patients. Pooled analysis of unadjusted data showed that vitamin D use in COVID-19 was significantly associated with reduced ICU admission/mortality (OR 0.41, 95% CI: 0.20, 0.81, p = 0.01, I 2 = 66%, random-effects model). Similarly, on pooling adjusted risk estimates, vitamin D was also found to reduce the risk of adverse outcomes (pooled OR 0.27, 95% CI: 0.08, 0.91, p = 0.03, I 2 = 80%, random-effects model). Subgroup analysis showed that vitamin D supplementation was associated with improved clinical outcomes only in patients receiving the drug post-COVID-19 diagnosis and not in those who had received vitamin D before diagnosis. Conclusions Vitamin D supplementation might be associated with improved clinical outcomes, especially when administered after the diagnosis of COVID-19. However, issues regarding the appropriate dose, duration, and mode of administration of vitamin D remain unanswered and need further research.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1007/ s40618-021-01614-4. Author contributions RP and MB are the co-primary authors, had performed literature search, data extraction and statistical analysis. SKB is the corresponding author, had conceptualized, supervised and edited the manuscript. AJS had helped in risk of bias assessment. BS and AV had helped in statistical analysis and had edited the manuscript. All the authors approved the final version of the manuscript.
Declarations
Conflicts of interest None to declare. Ethical approval This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent No informed consent. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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