Association and interaction between vitamin D level and metabolic syndrome for non-alcoholic fatty liver disease.

INTRODUCTION/OBJECTIVES: Previous studies have shown conflicting results regarding the association between hypovitaminosis D and non-alcoholic fatty liver disease (NAFLD). The aim of this study is to explore the individual and combined effect of hypovitaminosis D and metabolic syndrome (MS) on NAFLD. MATERIALS AND METHODS: In this cross-sectional study, 874 subjects were enrolled. 25(OH)D was assessed by a sequential competitive immuno-fluoro-assay method. The Fatty Liver Index (FLI) was used for NAFLD screening. Binary logistic regression and additive interaction were performed to investigate the association between vitamin D status, MS and NAFLD. RESULTS: Severe vitamin D deficiency was found to be positively related to NAFLD, with a higher risk in women than in men (OR = 6.4, 95% CI [2.8-15], p < 0.0001 vs. OR = 5.8, 95% CI [1.9-17.7], p = 0.002). In men, this association was partially masked by obesity. The additive interaction with MS was significant in women but not in men, the relative excess risk due to interaction was of 7.2, 95% CI [1.3-12.9], p = 0.02), the attributable proportion due to the combined effect was of 0.6, 95% CI [0.4-0.8], p < 0.0001. The interaction mechanism is synergistic; the synergy index: was of 2.9, 95% CI [1.6-5.3], p = 0.0006. CONCLUSION: A positive association has been found between severe vitamin D deficiency and NAFLD. Moreover, an excess risk in women combining both MS and severe vitamin D deficiency was quantified.

Vitamin D Deficiency and Low Serum Calcium as Predictors of Poor Prognosis in Patients with Severe COVID-19.

BACKGROUND: The severity of Coronavirus Disease 2019 (COVID-19) is a multifactorial condition. An increasing body of evidence argues for a direct implication of vitamin D deficiency, low serum calcium on poor outcomes in COVID-19 patients. This study was designed to investigate the relationship between these two factors and COVID-19 in-hospital mortality. MATERIALS: This is a prospective study, including 120 severe cases of COVID-19, admitted at the department of Reanimation-Anesthesia. Vitamin D was assessed by an immuno-fluoroassay method. Total serum calcium by a colorimetric method, then, corrected for serum albumin levels. The association with in-hospital mortality was assessed using the Kaplan-Meier survival curve, proportional Cox regression analyses and the receiver operating characteristic curve. RESULTS: Hypovitaminosis D and hypocalcemia were very common, occurring in 75% and 35.8% of patients. When analyzing survival, both were significantly associated with in-hospital mortality in a dose-effect manner (pLog-Rank = 0.009 and 0.001 respectively). A cutoff value of 39 nmol/l for vitamin D and 2.05 mmol/l for corrected calcemia could predict poor prognosis with a sensitivity of 76% and 84%, and a specificity of 69% and 60% respectively. Hazard ratios were (HR = 6.9, 95% CI [2.0-24.1], p = 0.002 and HR = 6.2, 95% CI [2.1-18.3], p = 0.001) respectively. CONCLUSION: This study demonstrates the high frequency of hypocalcemia and hypovitaminosis D in severe COVID-19 patients and provides further evidence of their potential link to poor short-term prognosis. It is, therefore, possible that the correction of hypocalcemia, as well as supplementation with vitamin D, may improve the vital prognosis.

Development and validation of a laboratory risk score for the early prediction of COVID-19 severity and in-hospital mortality.

BACKGROUND AND AIMS: Coronavirus Disease 2019 is characterized by a spectrum of clinical severity. This study aimed to develop a laboratory score system to identify high-risk individuals, to validate this score in a separate cohort, and to test its accuracy in the prediction of in-hospital mortality. METHODS: In this cohort study, biological data from 330 SARS-CoV-2 infected patients were used to develop a risk score to predict progression toward severity. In a second stage, data from 240 additional COVID-19 patients were used to validate this score. Accuracy of the score was measured by the area under the receiver operating characteristic curve (AUC). RESULTS: In the development cohort, a step-wise decrease in the average survival duration was noted with the increment of the risk score (pANOVA < 0.0001). A similar trend was confirmed when analyzing this association in the validation cohort (p < 0.0001). The AUC was 0.74 [0.66-0.82] and 0.90 [0.87-0.94], p < 0.0001, respectively for severity and mortality prediction. CONCLUSION: This study provides a useful risk score based on biological routine parameters assessed at the time of admission, which has proven its effectiveness in predicting both severity and short-term mortality of COVID-19. Improved predictive scores may be generated by including other clinical and radiological features.