Vitamin D status and its association with the severity of COVID-19 among hospitalized patients


  • Abir Hasan Dip Department of Cardiology, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh
  • Shaiful Azam Quadry Upazila Health Complex, Asamganj, Brahamanbaria, Bangladesh
  • M. Shariful Alam OSD, DOHS, Mohakhali, Dhaka, Bangladesh
  • M. Tanimul Haque Rijvy Jashore Medical College Hospital, Jashore, Bangladesh
  • Uma Dhar Department of Medicine, OSD, DOHS, Mohakhali, Dhaka, Bangladesh
  • Shilpy Akter Department of Dermatology, 250 Bedded Mohammad Ali Hospital, Bogura, Bangladesh
  • Hosneara Parvin 250 Bedded General Hospital, Jashore, Bangladesh
  • Mohammad Arbab Sarker Department of Paediatrics, OSD, DOHS, Mohakhali, Dhaka, Bangladesh
  • Shamim Ahmed Department of Respiratory Medicine, BSMMU, Dhaka, Bangladesh
  • Rajashish Chakrobortty Department of Respiratory Medicine, BSMMU, Dhaka, Bangladesh



COVID-19, Coronavirus disease 2019, SARS-CoV-2, ARDS


Background: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), causing COVID-19, manifests with outcomes ranging from mild to severe, even fatal. The reason for severe symptoms remains unclear. Vitamin D is implicated in the pathogenesis of severe COVID-19, including ARDS, cytokine storms, and thrombotic complications. The aim of this study was evaluation of vitamin D status and its association with the severity of COVID-19 patients attending Bangabandhu Sheikh Mujib medical University (BSMMU).

Methods: This cross-sectional study, conducted at BSMMU, Dhaka from January to December 2021, included 103 adult COVID-19-positive patients from both genders. Disease severity was assessed using WHO guidelines, and vitamin D levels recorded. Data were collected using a pre-designed datasheet after obtaining written informed consent.

Results: Among 103 COVID-19 patients, 55.3% were vitamin D deficient, 26.2% insufficient, and 18.4% sufficient. Most were male (65%) in their sixth and seventh decades. The mean vitamin D level was 20.97±10.96 ng/ml with a median of 18.10 ng/ml. Vitamin D deficiency was highest among critical patients (84.6%), followed by severe (71.1%), moderate (41.9%), and mild (28.6%) cases (p<0.001). Severe patients had a significantly higher deficiency rate (74.5%) compared to non-severe (36.5%) cases (p<0.001). Symptoms such as cough (96.5%), fever (89.5%), and shortness of breath (78.9%) were prevalent in the vitamin D deficiency group.

Conclusions: This study reveals a 55% prevalence of vitamin D deficiency in COVID-19 patients, correlating independently with disease severity. Hypertension and diabetes are notable comorbidities. It underscores the importance of assessing vitamin D levels in clinical practice.


Maghbooli Z, Sahraian MA, Ebrahimi M, Pazoki M, Kafan S, Tabriz HM, et al. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PloS one. 2020;15(9):e0239799.

Ye K, Tang F, Liao X, Shaw BA, Deng M, Huang G, et al. Does serum vitamin D level affect COVID-19 infection and its severity?-a case-control study. J Am College Nutr. 2021;40(8):724-31.

Worldometer2022, Countries where COVID-19. 2022. Available at: https: Accessed on 10 April, 2024.

Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: what we know. Int J Infect Dis. 2020;94:44-8.

Verdoia M, De Luca G. Potential role of hypovitaminosis D and vitamin D supplementation during COVID-19 pandemic. Int J Med. 2021;114(1):3-10.

Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of vitamin D status and other clinical characteristics with COVID-19 test results. JAMA Network Open. 2020;3(9):e2019722.

Baktash V, Hosack T, Patel N, Shah S, Kandiah P, Van den Abbeele K, et al. Vitamin D status and outcomes for hospitalised older patients with COVID-19. Postgraduate Med J. 2021;97(1149):442-7.

Mohan M, Cherian JJ, Sharma A. Exploring links between vitamin D deficiency and COVID-19. PLoS Pathogens. 2020;16(9):e1008874.

Razdan K, Singh K, Singh D. Vitamin D levels and COVID-19 susceptibility: is there any correlation? Med Drug Discovery. 2020;7:100051.

Zwart SR, Smith SM. Vitamin d and covid-19: lessons from spaceflight analogs. J Nutr. 2020;150(10):2624-7.

Lau FH, Majumder R, Torabi R, Saeg F, Hoffman R, Cirillo JD, et al. Vitamin D insufficiency is prevalent in severe COVID-19. MedRxiv. 2020;1-14.

Islam AM, Hasan MN, Rahman KM, Asaduzzaman M, Rahim MA, Zaman S, et al. Vitamin D status in Bangladeshi subjects: a laboratory-based study. BIRDEM Med J. 2019;9(3):202-6.

Ghasemian R, Shamshirian A, Heydari K, Malekan M, Alizadeh-Navaei R, Ebrahimzadeh MA, et al. The Role of Vitamin D in The Age of COVID-19: A Systematic Review and Meta-Analysis Along with an Ecological Approach. Int J Clin Pract. 2021;75(11):e14675.

Green SB. How many subjects does it take to do a regressionanalysis. Multivariate Behavioral Res. 1991;26(3):499-510.

Carpagnano GE, Di Lecce V, Quaranta VN, Zito A, Buonamico E, Capozza E, et al. Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19. J Endocrinological Investigation. 2021;44(4):765-71.

Mamani M, Muceli N, Basir HRG, Vasheghani M, Poorolajal J. Association between serum concentration of 25-hydroxyvitamin D and community-acquired pneumonia: a case-control study. Int J General Med. 2017;10:423.

Dancer RC, Parekh D, Lax S, D'Souza V, Zheng S, Bassford CR, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax. 2015;70(7):617-24.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Eng J Med. 2020;382(18):1708-20.

Farsalinos K, Bagos PG, Giannouchos T, Niaura R, Barbouni A, Poulas K. Smoking prevalence among hospitalized COVID-19 patients and its association with disease severity and mortality: an expanded re-analysis of a recent publication. Harm Reduction J. 2021;18(1):1-9.

Mohsin FM, Tonmon TT, Nahrin R, Tithy SA, Ame FA, Ara I, et al. Association Between Smoking and COVID-19 Severity: Evidence from Bangladesh. J Multidisciplinary Healthcare. 2021;141923.

Almehmadi M, Turjoman A, El-Askary A, Shafie A, Rebh F, Alenazi M, et al. Association of vitamin D deficiency with clinical presentation of COVID-19. Eur J Inflammation. 2021;19:1-10.

Karahan S, Katkat F. Impact of serum 25 (OH) vitamin D level on mortality in patients with COVID-19 in Turkey. J Nutrit Health Aging. 2021;25(2):189-96.

Radujkovic A, Hippchen T, Tiwari-Heckler S, Dreher S, Boxberger M, Merle U. Vitamin D Deficiency and Outcome of COVID-19 Patients. Nutrients. 2020;12(9):2757.






Original Research Articles