Abstract | November 6, 2020

The Association Between Vitamin D Deficiency and COVID-19 Severity in Prisma Health Patients

Presenting Author: Chloe A Schockling, Bachelor of Science, Medical Student, University of South Carolina School of Medicine Greenville, University of South Carolina School of Medicine Greenville, Greenville, South Carolina

Co-Authors: Alexandra North, BS, Medical Student, University of South Carolina School of Medicine Greenville, University of South Carolina School of Medicine, Greenville, SC; Banu Sivaraj, MS, PhD Candidate, Clemson University Department of Public Health Sciences, Clemson University, Clemson, SC; Brandon Lumsden, MS, PhD Candidate, Clemson UniversitySchool of Mathematical and Statistical Sciences, Clemson University, Clemson, SC; MacKenzie Stuenkel, MS, PhD Candidate, Clemson University Department of Public Health Sciences, Clemson University, Clemson, SC; Haritha Pavuluri, BS, Medical Student, University of South Carolina School of Medicine Greenville, University of South Carolina School of Medicine, Greenville, SC; Kurestin Miller, BA, Medical Student, University of South Carolina School of Medicine Greenville, University of South Carolina School of Medicine, Greenville, SC; John Reddic, PhD, Technical Laboratory Director, Prisma Health Technical Laboratory, Prisma Health Upstate, Greenville, SC; Corey Kalbaugh, PhD, Assistant Professor, Clemson University Department of Public Health Sciences, Clemson University, Clemson, SC; Lior Rennert, PhD, Assistant Professor, Clemson University Department of Public Health Sciences, Clemson University, Clemson, SC; Smith Heavner-Sullivan, RN, MS, Manager of Clinical Trials Researc, Prisma Health Department of Medicine, Prisma Health Upstate, Greenville, SC, Lu Zhang, PhD, Assistant Professor, Clemson University Department of Public Health Sciences, Clemson University, Clemson, SC, Arwen Declan, PhD, Assistant Research Director, Prisma Health Department of Emergency Medicine, Prisma Health Upstate, Greenville, SC.

Learning Objectives

  1. Upon completion of this lecture, learners should be better prepared to:Describe the association between vitamin D deficiency and COVID-19 disease severity.
  2. Upon completion of this lecture, learners should be better prepared to: Expand our understanding of the host-level factors that contribute to COVID-19 severity.
  3. Upon completion of this lecture, learners should be better prepared to: Identify opportunities for further research that target improving outcomes for medically underserved communities that are more likely to suffer from Vitamin D deficiency and worse COVID-19 outcomes.

Background/Knowledge Gap: The novel pandemic viral disease COVID-19, caused by the coronavirus Sars-CoV-2, causes extensive morbidity and mortality. As there is no proven treatment, the study of immunoprotective factors is critical. Vitamin D, is an essential vitamin with immunoprotective, anti-microbial, and anti-inflammatory properties. Vitamin D is thought to modulate components of the immunological surge associated with severe COVID-19. Thus, we hypothesize that vitamin D deficiency modulates the presentation, course, and outcome of COVID-19 patients.

Methods/Design: This retrospective cohort study examines the correlation between COVID-19 disease severity and historical vitamin D levels. The primary outcome is disease severity, quantified as the worst daily score from each patient’s daily World Health Organization Clinical Progression Scale. This scale stratifies disease severity by factors such as hospitalization, need for supplemental oxygenation, laboratory values that reflect oxygen delivery, and use of physiological replacement technologies such as mechanical ventilation and dialysis. Secondary outcomes include the number of emergency department visits, Emergency Severity Index at presentation for ED patients, and length of stay. We will use historical vitamin D levels obtained in the 3 years before COVID-19 testing to identify probable vitamin D deficiency and insufficiency. We will use multivariable logistic and linear regression models to analyze retrospective data abstracted from the Prisma Health Rapid Innovation Task Force COVID-19 Registry to control for age, race, sex, smoking history, comorbidities, and presentation site as well as seasonality of prior vitamin D testing.

Conclusions/Implications: We propose that optimizing vitamin D levels will improve patient outcomes, particularly in the underserved communities most likely to suffer vitamin D deficiency. This pivotal research will clarify the effect of vitamin D deficiency on COVID-19 disease severity, establish a foundation for further study of vitamin D supplementation in COVID-19 patients, and advance understanding of the pandemic disease COVID-19.

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