Pneumonia 6X more likely if very low vitamin D – meta-analysis Sept 2019

The association between vitamin D deficiency and community-acquired pneumonia - A meta-analysis of observational studies

Medicine (Baltimore). 2019 Sep; 98(38): doi: 10.1097/MD.0000000000017252
Yun-Fang Zhou, MM,a Bang-An Luo, MM,b,∗ and Lu-Lu Qin, MD, PhDc,∗

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If Vitamin D <10ng

Emerging evidence has shown that vitamin D deficiency may be related with community-acquired pneumonia (CAP), but individually published studies showed inconclusive results. The aim of this study was to quantitatively summarize the association between vitamin D and the CAP.

We conducted this meta-analysis though a systematic literature search of PubMed, Medline, and EMBASE up to 31 September 2018 with the following keywords ‘vitamin D’ or ‘cholecalciferol’ or ‘25-hydroxyvitamin D’ or ‘25(OH)D’ in combination with ‘community-acquired pneumonia’ or ‘CAP’ or ‘pneumonia’ with no limitations. This meta-analysis was performed following the guidelines of Meta-analysis of Observational Studies in Epidemiology. The association between vitamin D levels and CAP were measured as odds ratio (OR) and weighted mean difference (WMD). Results were combined using a random-effect or a fix-effect meta-analysis, and sensitivity analyses were conducted to explore potential factors.

Eight observational studies involving 20,966 subjects were included. In this meta-analysis, CAP patients with vitamin D deficiency (serum 25(OH)D levels <20 ng/mL) experienced a significantly increased risk of CAP (odds ratio (OR) = 1.64, 95% confidence intervals (CI): 1.00, 2.67), and an obvious decrease of −5.63 ng/mL (95% CI: −9.11, −2.14) in serum vitamin D was demonstrated in CAP patients. Sensitivity analysis showed that exclusion of any single study did not materially alter the overall combined effect.

The evidence from this meta-analysis indicates an association between vitamin D deficiency and an increased risk of CAP patients. However, well-designed trails are required to determine the explicit effect of vitamin D supplementation.

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Clipped from PDF

• "The patients of CAP in the US was estimated to be 5.6 million every year, among which about 1.1 million patients that needed hospitalization.1 The average in-hospital duration of CAP patients was 1 week in the US, the 30-day mortality rate was above 20%, and the mortality rate within 1 year of CAP patients after discharge was about 30%"
• "A total of 20,966 participants were consisted of various ethnicities. Age ranged from 3 days to 94 years old, ..."
• "...death rates of CAP patients during in-hospital treatment were far higher than other causes of death and ranked second among all in-hospital patients"
• "...severe vitamin D deficiency (SVDD), with high heterogeneity (OR= 6.65, 95%CI: 2.58, 17.15, I2=90%)
  • Note: SVDD is < 10 ng