Vitamin D supplementation and clinical outcomes in COVID-19: a systematic review and meta-analysis

Abstract

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, I² = 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, I² = 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.

Keywords: COVID-19; ICU admission; Mortality; Vitamin D.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart showing the study selection process

Fig. 2

Forest plot showing the effect (unadjusted) of vitamin D supplementation on clinical outcomes (intensive care unit admission and/or mortality) in patients with COVID-19 as compared to non-use of vitamin D

Fig. 3

Forest plot with subgroup analysis (based on the use of vitamin D pre- or post-COVID-19 diagnosis) showing the effect (unadjusted) of vitamin D supplementation on clinical outcomes (intensive care unit admission and/or mortality) in patients with COVID-19 as compared to non-use of vitamin D

Fig. 4

Forest plots showing the effect (adjusted) of vitamin D supplementation on clinical outcomes (intensive care unit admission and/or mortality) in patients with COVID-19 as compared to non-use of vitamin D expressed either as pooled odds ratio (A) or pooled hazard ratio (B)