{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:16:03Z","timestamp":1791814563039,"version":"4.3.4"},"reference-count":35,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T00:00:00Z","timestamp":1658793600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of General Medical Sciences","award":["5U54GM104942-04"],"award-info":[{"award-number":["5U54GM104942-04"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>It is unclear whether vitamin D benefits inpatients with COVID-19. Objective: To examine the relationship between vitamin D and COVID-19 outcomes. Design: Cohort study. Setting: National COVID Cohort Collaborative (N3C) database. Patients: 158,835 patients with confirmed COVID-19 and a sub-cohort with severe disease (n = 81,381) hospitalized between 1 January 2020 and 31 July 2021. Methods: We identified vitamin D prescribing using codes for vitamin D and its derivatives. We created a sub-cohort defined as having severe disease as those who required mechanical ventilation or extracorporeal membrane oxygenation (ECMO), had hospitalization &gt;5 days, or hospitalization ending in death or hospice. Using logistic regression, we adjusted for age, sex, race, BMI, Charlson Comorbidity Index, and urban\/rural residence, time period, and study site. Outcomes of interest were death or transfer to hospice, longer length of stay, and mechanical ventilation\/ECMO. Results: Patients treated with vitamin D were older, had more comorbidities, and higher BMI compared with patients who did not receive vitamin D. Vitamin D treatment was associated with an increased odds of death or referral for hospice (adjusted odds ratio (AOR) 1.10: 95% CI 1.05\u20131.14), hospital stay &gt;5 days (AOR 1.78: 95% CI 1.74\u20131.83), and increased odds of mechanical ventilation\/ECMO (AOR 1.49: 95% CI 1.44\u20131.55). In the sub-cohort of severe COVID-19, vitamin D decreased the odds of death or hospice (AOR 0.90, 95% CI 0.86\u20130.94), but increased the odds of hospital stay longer &gt;5 days (AOR 2.03, 95% CI 1.87\u20132.21) and mechanical ventilation\/ECMO (AOR 1.16, 95% CI 1.12\u20131.21). Limitations: Our findings could reflect more aggressive treatment due to higher severity. Conclusion: Vitamin D treatment was associated with greater odds of extended hospitalization, mechanical ventilation\/ECMO, and death or hospice referral.<\/jats:p>","DOI":"10.3390\/nu14153073","type":"journal-article","created":{"date-parts":[[2022,7,27]],"date-time":"2022-07-27T04:59:16Z","timestamp":1658897956000},"page":"3073","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Association of Vitamin D Prescribing and Clinical Outcomes in Adults Hospitalized with COVID-19"],"prefix":"10.3390","volume":"14","author":[{"given":"Kathleen M.","family":"Fairfield","sequence":"first","affiliation":[{"name":"MaineHealth Institute for Research, Portland, ME 04074, USA"},{"name":"Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Murray","sequence":"additional","affiliation":[{"name":"MaineHealth Institute for Research, Portland, ME 04074, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3212-7845","authenticated-orcid":false,"given":"A. Jerrod","family":"Anzalone","sequence":"additional","affiliation":[{"name":"Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Beasley","sequence":"additional","affiliation":[{"name":"Biomedical and Behavioral Methodology Core, University of Oklahoma, Norman, OK 73019, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7559-1656","authenticated-orcid":false,"given":"Maryam","family":"Khodaverdi","sequence":"additional","affiliation":[{"name":"West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, WV 26506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally L.","family":"Hodder","sequence":"additional","affiliation":[{"name":"West Virginia Clinical and Translational Science Institute, West Virginia University School of Medicine, Morgantown, WV 26506, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Harper","sequence":"additional","affiliation":[{"name":"Owl Health Works LLC, Indianapolis, IN 46278, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Santangelo","sequence":"additional","affiliation":[{"name":"MaineHealth Institute for Research, Portland, ME 04074, USA"},{"name":"Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford J.","family":"Rosen","sequence":"additional","affiliation":[{"name":"MaineHealth Institute for Research, Portland, ME 04074, USA"},{"name":"Department of Medicine, Tufts University School of Medicine, Boston, MA 02111, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the N3C Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,26]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2022, June 10). WHO Coronavirus (COVID-19) Dashboard. Available online: https:\/\/covid19.who.int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/ncpendmet0716","article-title":"Unexpected actions of vitamin D: New perspectives on the regulation of innate and adaptive immunity","volume":"4","author":"Adams","year":"2008","journal-title":"Nat. Clin. Pract. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.mce.2010.02.013","article-title":"Vitamin D and the intracrinology of innate immunity","volume":"321","author":"Hewison","year":"2010","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e210554","DOI":"10.1530\/EC-21-0554","article-title":"Autoimmune disease and interconnections with vitamin D","volume":"11","author":"Fletcher","year":"2022","journal-title":"Endocr. Connect."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e10405","DOI":"10.1002\/jbm4.10405","article-title":"Vitamin D and Immune Regulation: Antibacterial, Antiviral, Anti-Inflammatory","volume":"5","author":"Bishop","year":"2021","journal-title":"JBMR Plus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1126\/science.6310748","article-title":"1,25-Dihydroxyvitamin D3 Receptors in Human Leukocytes","volume":"221","author":"Provvedini","year":"1983","journal-title":"Science"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2734","DOI":"10.4049\/jimmunol.136.8.2734","article-title":"1 alpha,25-Dihydroxyvitamin D3-binding macromolecules in human B lymphocytes: Effects on immunoglobulin production","volume":"136","author":"Provvedini","year":"1986","journal-title":"J. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1210\/jcem-57-6-1308","article-title":"Specific high-affinity receptors for 1,25-dihydroxyvitamin D3 in human peripheral blood mononuclear cells: Presence in monocytes and induction in t lymphocytes following activation","volume":"57","author":"Bhalla","year":"1983","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4240","DOI":"10.3390\/nu7064240","article-title":"Modulation of the Immune Response to Respiratory Viruses by Vitamin, D","volume":"7","author":"Greiller","year":"2015","journal-title":"Nutrients"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"White, J.H. (2022). Emerging Roles of Vitamin D-Induced Antimicrobial Peptides in Antiviral Innate Immunity. Nutrients, 14.","DOI":"10.3390\/nu14020284"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.4049\/jimmunol.1102412","article-title":"Vitamin D Inhibits Monocyte\/Macrophage Proinflammatory Cytokine Production by Targeting MAPK Phosphatase-1","volume":"188","author":"Zhang","year":"2012","journal-title":"J. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"R133","DOI":"10.1530\/EJE-20-0665","article-title":"Mechanisms in Endocrinology: Vitamin D and COVID-19","volume":"183","author":"Bilezikian","year":"2020","journal-title":"Eur. J. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"G\u00f6nen, M.S., Alayl\u0131o\u011flu, M., Durcan, E., \u00d6zdemir, Y., \u015eahin, S., Konuko\u011flu, D., Nohut, O.K., \u00dcrkmez, S., K\u00fc\u00e7\u00fckece, B., and Balkan, I.I. (2021). Rapid and Effective Vitamin D Supplementation May Present Better Clinical Outcomes in COVID-19 (SARS-CoV-2) Patients by Altering Serum INOS1, IL1B, IFNg, Cathelicidin-LL37, and ICAM1. Nutrients, 13.","DOI":"10.3390\/nu13114047"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1136\/thoraxjnl-2014-206680","article-title":"Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS)","volume":"70","author":"Dancer","year":"2015","journal-title":"Thorax"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/S8756-3282(02)00692-0","article-title":"Serum 25-hydroxyvitamin D status of adolescents and adults in two seasonal subpopulations from NHANES III","volume":"30","author":"Looker","year":"2002","journal-title":"Bone"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/ajcn\/72.3.690","article-title":"Decreased bioavailability of vitamin D in obesity","volume":"72","author":"Wortsman","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"454","DOI":"10.3945\/ajcn.115.127985","article-title":"The vitamin D status of the US population from 1988 to 2010 using standardized serum concentrations of 25-hydroxyvitamin D shows recent modest increases","volume":"104","author":"Schleicher","year":"2016","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1016\/j.clnu.2017.05.006","article-title":"Vitamin D supplementation in the critically ill: A systematic review and meta-analysis","volume":"37","author":"Langlois","year":"2018","journal-title":"Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sabico, S., Enani, M.A., Sheshah, E., Aljohani, N.J., Aldisi, D.A., Alotaibi, N.H., Alshingetti, N., Alomar, S.Y., Alnaami, A.M., and Amer, O.E. (2021). Effects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate COVID-19: A Randomized Clinical Trial. Nutrients, 13.","DOI":"10.3390\/nu13072170"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s00394-020-02372-4","article-title":"Vitamin D and COVID-19 infection and mortality in UK Biobank","volume":"60","author":"Hastie","year":"2021","journal-title":"Eur. J. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hosseini, B., El Abd, A., and Ducharme, F.M. (2022). Effects of Vitamin D Supplementation on COVID-19 Related Outcomes: A Systematic Review and Meta-Analysis. Nutrients, 14.","DOI":"10.3390\/nu14102134"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1001\/jama.2020.26848","article-title":"Effect of a Single High Dose of Vitamin D3 on Hospital Length of Stay in Patients with Moderate to Severe COVID-19: A Randomized Clinical Trial","volume":"325","author":"Murai","year":"2021","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1093\/jamia\/ocaa196","article-title":"The National COVID Cohort Collaborative (N3C): Rationale, design, infrastructure, and deployment","volume":"28","author":"Haendel","year":"2021","journal-title":"J. Am. Med. Inform. Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e2116901","DOI":"10.1001\/jamanetworkopen.2021.16901","article-title":"Clinical Characterization and Prediction of Clinical Severity of SARS-CoV-2 Infection Among US Adults Using Data From the US National COVID Cohort Collaborative","volume":"4","author":"Bennett","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1017\/ice.2021.110","article-title":"Monthly trend in mortality and length of stay among coronavirus disease 2019 (COVID-19) patients: Analysis of a nationwide multihospital US database","volume":"42","author":"Fan","year":"2021","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e210417","DOI":"10.1001\/jamanetworkopen.2021.0417","article-title":"Outcomes and Mortality Among Adults Hospitalized with COVID-19 at US Medical Centers","volume":"4","author":"Nguyen","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J. Clin. Epidemiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v042.i08","article-title":"MatchIt: Nonparametric Preprocessing for Parametric Causal Inference","volume":"42","author":"Ho","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1093\/ajcn\/nqab151","article-title":"Influence of vitamin D status on hospital length of stay and prognosis in hospitalized patients with moderate to severe COVID-19: A multicenter prospective cohort study","volume":"114","author":"Reis","year":"2021","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s40618-021-01639-9","article-title":"Vitamin D supplementation and COVID-19 risk: A population-based, cohort study","volume":"45","author":"Oristrell","year":"2022","journal-title":"J. Endocrinol. Investig."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Shah, K., Varna, V.P., Sharma, U., and Mavalankar, D. (2022). Does vitamin D supplementation reduce COVID-19 severity?\u2014A systematic review. QJM.","DOI":"10.1093\/qjmed\/hcac040"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"836738","DOI":"10.3389\/fphar.2022.836738","article-title":"The Role of Vitamin D in COVID-19 and the Impact of Pandemic Restrictions on Vitamin D Blood Content","volume":"13","author":"Tomaszewska","year":"2022","journal-title":"Front. Pharmacol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.7861\/clinmed.2020-0301","article-title":"Does vitamin D deficiency increase the severity of COVID-19?","volume":"20","author":"Weir","year":"2020","journal-title":"Clin. Med."},{"key":"ref_34","first-page":"275","article-title":"Vitamin D deficiency in the ICU: A systematic review","volume":"39","author":"Zajic","year":"2014","journal-title":"Minerva Endocrinol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1001\/jama.2014.13204","article-title":"Effect of High-Dose Vitamin D3 on Hospital Length of Stay in Critically Ill Patients with Vitamin D Deficiency: The VITdAL-ICU randomized clinical trial","volume":"312","author":"Amrein","year":"2014","journal-title":"JAMA"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/15\/3073\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:57:04Z","timestamp":1760140624000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/15\/3073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,26]]},"references-count":35,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["nu14153073"],"URL":"https:\/\/doi.org\/10.3390\/nu14153073","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,26]]}}}