AUTHOR=Al Sulaiman Khalid , Korayem Ghazwa B. , Aljuhani Ohoud , Altebainawi Ali F. , Shawaqfeh Mohammad S. , Alarfaj Sumaiah J. , Alharbi Reham A. , Ageeli Mawaddah M. , Alissa Abdulrahman , Vishwakarma Ramesh , Ibrahim Alnada , Alenazi Abeer A. , Alghnam Suliman , Alshehri Nadiyah , Alshammari Maqbulah M. , Alhubaishi Alaa , Aldhaeefi Mohammed , Alamri Faisal F. , Syed Yadullah , Khan Raymond , Alalawi Mai , Alanazi Khalaf A. , Alresayes Faisal S. , Albarqi Khalid J. , Al Ghamdi Ghassan TITLE=Survival implications vs. complications: unraveling the impact of vitamin D adjunctive use in critically ill patients with COVID-19—A multicenter cohort study JOURNAL=Frontiers in Medicine VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1237903 DOI=10.3389/fmed.2023.1237903 ISSN=2296-858X ABSTRACT=Background

Despite insufficient evidence, vitamin D has been used as adjunctive therapy in critically ill patients with COVID-19. This study evaluates the effectiveness and safety of vitamin D as an adjunctive therapy in critically ill COVID-19 patients.

Methods

A multicenter retrospective cohort study that included all adult COVID-19 patients admitted to the intensive care units (ICUs) between March 2020 and July 2021. Patients were categorized into two groups based on their vitamin D use throughout their ICU stay (control vs. vitamin D). The primary endpoint was in-hospital mortality. Secondary outcomes were the length of stay (LOS), mechanical ventilation (MV) duration, and ICU-acquired complications. Propensity score (PS) matching (1:1) was used based on the predefined criteria. Multivariable logistic, Cox proportional hazards, and negative binomial regression analyses were employed as appropriate.

Results

A total of 1,435 patients were included in the study. Vitamin D was initiated in 177 patients (12.3%), whereas 1,258 patients did not receive it. A total of 288 patients were matched (1:1) using PS. The in-hospital mortality showed no difference between patients who received vitamin D and the control group (HR 1.22, 95% CI 0.87–1.71; p = 0.26). However, MV duration and ICU LOS were longer in the vitamin D group (beta coefficient 0.24 (95% CI 0.00–0.47), p = 0.05 and beta coefficient 0.16 (95% CI −0.01 to 0.33), p = 0.07, respectively). As an exploratory outcome, patients who received vitamin D were more likely to develop major bleeding than those who did not [OR 3.48 (95% CI 1.10, 10.94), p = 0.03].

Conclusion

The use of vitamin D as adjunctive therapy in COVID-19 critically ill patients was not associated with survival benefits but was linked with longer MV duration, ICU LOS, and higher odds of major bleeding.