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dc.contributor.authorHurst, Emma A
dc.contributor.authorMellanby, Richard J
dc.contributor.authorHandel, Ian
dc.contributor.authorGriffith, David M
dc.contributor.authorRossi, Adriano G
dc.contributor.authorWalsh, Timothy S
dc.contributor.authorShankar-Hari, Manu
dc.contributor.authorDunning, Jake
dc.contributor.authorHomer, Natalie Z
dc.contributor.authorDenham, Scott G
dc.contributor.authorDevine, Kerri
dc.contributor.authorHolloway, Paul A
dc.contributor.authorMoore, Shona C
dc.contributor.authorThwaites, Ryan S
dc.contributor.authorSamanta, Romit J
dc.contributor.authorHardwick, Hayley E
dc.contributor.authorOosthuyzen, Wilna
dc.contributor.authorTurtle, Lance
dc.contributor.authorSemple, Malcolm G
dc.contributor.authorOpenshaw, Peter J M
dc.contributor.authorBaillie, J Kenneth
dc.contributor.authorISARIC4C Investigators
dc.contributor.authorKenneth Baillie, J
dc.contributor.authorCarson, Gail
dc.contributor.authorAlex, Beatrice
dc.contributor.authorBach, Benjamin
dc.contributor.authorBarclay, Wendy S
dc.contributor.authorBogaert, Debby
dc.contributor.authorChand, Meera
dc.contributor.authorCooke, Graham S
dc.contributor.authorDocherty, Annemarie B
dc.contributor.authorFilipe, Ana da Silva
dc.contributor.authorFletcher, Tom
dc.contributor.authorGreen, Christopher A
dc.contributor.authorHarrison, Ewen M
dc.contributor.authorHiscox, Julian A
dc.contributor.authorHorby, Peter W
dc.contributor.authorIjaz, Samreen
dc.contributor.authorKhoo, Saye
dc.contributor.authorKlenerman, Paul
dc.contributor.authorLaw, Andrew
dc.contributor.authorLim, Wei Shen
dc.contributor.authorMentzer, Alexander J
dc.contributor.authorMerson, Laura
dc.contributor.authorMeynert, Alison M
dc.contributor.authorNoursadeghi, Mahdad
dc.contributor.authorPalmarini, Massimo
dc.contributor.authorPaxton, William A
dc.contributor.authorPollakis, Georgios
dc.contributor.authorPrice, Nicholas
dc.contributor.authorRambaut, Andrew
dc.contributor.authorRobertson, David L
dc.contributor.authorRussell, Clark D
dc.contributor.authorSancho-Shimizu, Vanessa
dc.contributor.authorScott, Janet T
dc.contributor.authorSilva, Thushan de
dc.contributor.authorSigfrid, Louise
dc.contributor.authorSolomon, Tom
dc.contributor.authorSriskandan, Shiranee
dc.contributor.authorStuart, David
dc.contributor.authorSummers, Charlotte
dc.contributor.authorTedder, Richard S
dc.contributor.authorThomson, Emma C
dc.contributor.authorRoger Thompson, A A
dc.contributor.authorTurtle, Lance C W
dc.contributor.authorGupta, Rishi K
dc.contributor.authorZambon, Maria
dc.contributor.authorHardwick, Hayley
dc.contributor.authorDonohue, Chloe
dc.contributor.authorLyons, Ruth
dc.contributor.authorGriffiths, Fiona
dc.contributor.authorNorman, Lisa
dc.contributor.authorPius, Riinu
dc.contributor.authorDrake, Thomas M
dc.contributor.authorFairfield, Cameron J
dc.contributor.authorKnight, Stephen R
dc.contributor.authorMclean, Kenneth A
dc.contributor.authorMurphy, Derek
dc.contributor.authorShaw, Catherine A
dc.contributor.authorDalton, Jo
dc.contributor.authorGirvan, Michelle
dc.contributor.authorSaviciute, Egle
dc.contributor.authorRoberts, Stephanie
dc.contributor.authorHarrison, Janet
dc.contributor.authorMarsh, Laura
dc.contributor.authorConnor, Marie
dc.contributor.authorHalpin, Sophie
dc.contributor.authorJackson, Clare
dc.contributor.authorGamble, Carrol
dc.contributor.authorLeeming, Gary
dc.contributor.authorWham, Murray
dc.contributor.authorClohisey, Sara
dc.contributor.authorHendry, Ross
dc.contributor.authorScott-Brown, James
dc.contributor.authorGreenhalf, William
dc.contributor.authorShaw, Victoria
dc.contributor.authorMcDonald, Sara
dc.contributor.authorKeating, Seán
dc.contributor.authorAhmed, Katie A
dc.contributor.authorArmstrong, Jane A
dc.contributor.authorAshworth, Milton
dc.contributor.authorAsiimwe, Innocent G
dc.contributor.authorBakshi, Siddharth
dc.contributor.authorBarlow, Samantha L
dc.contributor.authorBooth, Laura
dc.contributor.authorBrennan, Benjamin
dc.contributor.authorBullock, Katie
dc.contributor.authorCatterall, Benjamin W A
dc.contributor.authorClark, Jordan J
dc.contributor.authorClarke, Emily A
dc.contributor.authorCole, Sarah
dc.contributor.authorCooper, Louise
dc.contributor.authorCox, Helen
dc.contributor.authorDavis, Christopher
dc.contributor.authorDincarslan, Oslem
dc.contributor.authorDunn, Chris
dc.contributor.authorDyer, Philip
dc.contributor.authorElliott, Angela
dc.contributor.authorEvans, Anthony
dc.contributor.authorFinch, Lorna
dc.contributor.authorFisher, Lewis W S
dc.contributor.authorFoster, Terry
dc.contributor.authorGarcia-Dorival, Isabel
dc.contributor.authorGunning, Philip
dc.contributor.authorHartley, Catherine
dc.contributor.authorJensen, Rebecca L
dc.contributor.authorJones, Christopher B
dc.contributor.authorJones, Trevor R
dc.contributor.authorKhandaker, Shadia
dc.contributor.authorKing, Katharine
dc.contributor.authorKiy, Robyn T
dc.contributor.authorKoukorava, Chrysa
dc.contributor.authorLake, Annette
dc.contributor.authorLant, Suzannah
dc.contributor.authorLatawiec, Diane
dc.contributor.authorLavelle-Langham, Lara
dc.contributor.authorLefteri, Daniella
dc.contributor.authorLett, Lauren
dc.contributor.authorLivoti, Lucia A
dc.contributor.authorMancini, Maria
dc.contributor.authorMcDonald, Sarah
dc.contributor.authorMcEvoy, Laurence
dc.contributor.authorMcLauchlan, John
dc.contributor.authorMetelmann, Soeren
dc.contributor.authorMiah, Nahida S
dc.contributor.authorMiddleton, Joanna
dc.contributor.authorMitchell, Joyce
dc.contributor.authorMurphy, Ellen G
dc.contributor.authorPenrice-Randal, Rebekah
dc.contributor.authorPilgrim, Jack
dc.contributor.authorPrince, Tessa
dc.contributor.authorReynolds, Will
dc.contributor.authorMatthew Ridley, P
dc.contributor.authorSales, Debby
dc.contributor.authorShaw, Victoria E
dc.contributor.authorShears, Rebecca K
dc.contributor.authorSmall, Benjamin
dc.contributor.authorSubramaniam, Krishanthi S
dc.contributor.authorSzemiel, Agnieska
dc.contributor.authorTaggart, Aislynn
dc.contributor.authorTanianis-Hughes, Jolanta
dc.contributor.authorThomas, Jordan
dc.contributor.authorTrochu, Erwan
dc.contributor.authorTonder, Libby van
dc.contributor.authorWilcock, Eve
dc.contributor.authorEunice Zhang, J
dc.contributor.authorFlaherty, Lisa
dc.contributor.authorMaziere, Nicole
dc.contributor.authorCass, Emily
dc.contributor.authorCarracedo, Alejandra Doce
dc.contributor.authorCarlucci, Nicola
dc.contributor.authorHolmes, Anthony
dc.contributor.authorMassey, Hannah
dc.contributor.authorMurphy, Lee
dc.contributor.authorWrobel, Nicola
dc.contributor.authorMcCafferty, Sarah
dc.contributor.authorMorrice, Kirstie
dc.contributor.authorMacLean, Alan
dc.contributor.authorAdeniji, Kayode
dc.contributor.authorAgranoff, Daniel
dc.contributor.authorAgwuh, Ken
dc.contributor.authorAil, Dhiraj
dc.contributor.authorAldera, Erin L
dc.contributor.authorAlegria, Ana
dc.contributor.authorAngus, Brian
dc.contributor.authorAshish, Abdul
dc.contributor.authorAtkinson, Dougal
dc.contributor.authorBari, Shahedal
dc.contributor.authorBarlow, Gavin
dc.contributor.authorBarnass, Stella
dc.contributor.authorBarrett, Nicholas
dc.contributor.authorBassford, Christopher
dc.contributor.authorBasude, Sneha
dc.contributor.authorBaxter, David
dc.contributor.authorBeadsworth, Michael
dc.contributor.authorBernatoniene, Jolanta
dc.contributor.authorBerridge, John
dc.contributor.authorBest, Nicola
dc.contributor.authorBothma, Pieter
dc.contributor.authorChadwick, David
dc.contributor.authorBrittain-Long, Robin
dc.contributor.authorBulteel, Naomi
dc.contributor.authorBurden, Tom
dc.contributor.authorBurtenshaw, Andrew
dc.contributor.authorCaruth, Vikki
dc.contributor.authorChambler, Duncan
dc.contributor.authorChee, Nigel
dc.contributor.authorChild, Jenny
dc.contributor.authorChukkambotla, Srikanth
dc.contributor.authorClark, Tom
dc.contributor.authorCollini, Paul
dc.contributor.authorCosgrove, Catherine
dc.contributor.authorCupitt, Jason
dc.contributor.authorCutino-Moguel, Maria-Teresa
dc.contributor.authorDark, Paul
dc.contributor.authorDawson, Chris
dc.contributor.authorDervisevic, Samir
dc.contributor.authorDonnison, Phil
dc.contributor.authorDouthwaite, Sam
dc.contributor.authorDuRand, Ingrid
dc.contributor.authorDushianthan, Ahilanadan
dc.contributor.authorDyer, Tristan
dc.contributor.authorEvans, Cariad
dc.contributor.authorEziefula, Chi
dc.contributor.authorFegan, Chrisopher
dc.contributor.authorFinn, Adam
dc.contributor.authorFullerton, Duncan
dc.contributor.authorGarg, Sanjeev
dc.contributor.authorGarg, Atul
dc.contributor.authorGkrania-Klotsas, Effrossyni
dc.contributor.authorGodden, Jo
dc.contributor.authorGoldsmith, Arthur
dc.contributor.authorGraham, Clive
dc.contributor.authorHardy, Elaine
dc.contributor.authorHartshorn, Stuart
dc.contributor.authorHarvey, Daniel
dc.contributor.authorHavalda, Peter
dc.contributor.authorHawcutt, Daniel B
dc.contributor.authorHobrok, Maria
dc.contributor.authorHodgson, Luke
dc.contributor.authorHormis, Anil
dc.contributor.authorJacobs, Michael
dc.contributor.authorJain, Susan
dc.contributor.authorJennings, Paul
dc.contributor.authorKaliappan, Agilan
dc.contributor.authorKasipandian, Vidya
dc.contributor.authorKegg, Stephen
dc.contributor.authorKelsey, Michael
dc.contributor.authorKendall, Jason
dc.contributor.authorKerrison, Caroline
dc.contributor.authorKerslake, Ian
dc.contributor.authorKoch, Oliver
dc.contributor.authorKoduri, Gouri
dc.contributor.authorKoshy, George
dc.contributor.authorLaha, Shondipon
dc.contributor.authorLaird, Steven
dc.contributor.authorLarkin, Susan
dc.contributor.authorLeiner, Tamas
dc.contributor.authorLillie, Patrick
dc.contributor.authorLimb, James
dc.contributor.authorLinnett, Vanessa
dc.contributor.authorLittle, Jeff
dc.contributor.authorLyttle, Mark
dc.contributor.authorMacMahon, Michael
dc.contributor.authorMacNaughton, Emily
dc.contributor.authorMankregod, Ravish
dc.contributor.authorMasson, Huw
dc.contributor.authorMatovu, Elijah
dc.contributor.authorMcCullough, Katherine
dc.contributor.authorMcEwen, Ruth
dc.contributor.authorMeda, Manjula
dc.contributor.authorMills, Gary
dc.contributor.authorMinton, Jane
dc.contributor.authorMirfenderesky, Mariyam
dc.contributor.authorMohandas, Kavya
dc.contributor.authorMok, Quen
dc.contributor.authorMoon, James
dc.contributor.authorMoore, Elinoor
dc.contributor.authorMorgan, Patrick
dc.contributor.authorMorris, Craig
dc.contributor.authorMortimore, Katherine
dc.contributor.authorMoses, Samuel
dc.contributor.authorMpenge, Mbiye
dc.contributor.authorMulla, Rohinton
dc.contributor.authorMurphy, Michael
dc.contributor.authorNagel, Megan
dc.contributor.authorNagarajan, Thapas
dc.contributor.authorNelson, Mark
dc.contributor.authorO'Shea, Matthew K
dc.contributor.authorOtahal, Igor
dc.contributor.authorOstermann, Marlies
dc.contributor.authorPais, Mark
dc.contributor.authorPalmieri, Carlo
dc.contributor.authorPanchatsharam, Selva
dc.contributor.authorPapakonstantinou, Danai
dc.contributor.authorParaiso, Hassan
dc.contributor.authorPatel, Brij
dc.contributor.authorPattison, Natalie
dc.contributor.authorPepperell, Justin
dc.contributor.authorPeters, Mark
dc.contributor.authorPhull, Mandeep
dc.contributor.authorPintus, Stefania
dc.contributor.authorPooni, Jagtur Singh
dc.contributor.authorPost, Frank
dc.contributor.authorPrice, David
dc.contributor.authorProut, Rachel
dc.contributor.authorRae, Nikolas
dc.contributor.authorReschreiter, Henrik
dc.contributor.authorReynolds, Tim
dc.contributor.authorRichardson, Neil
dc.contributor.authorRoberts, Mark
dc.contributor.authorRoberts, Devender
dc.contributor.authorRose, Alistair
dc.contributor.authorRousseau, Guy
dc.contributor.authorRyan, Brendan
dc.contributor.authorSaluja, Taranprit
dc.contributor.authorShah, Aarti
dc.contributor.authorShanmuga, Prad
dc.contributor.authorSharma, Anil
dc.contributor.authorShawcross, Anna
dc.contributor.authorSizer, Jeremy
dc.contributor.authorSmith, Richard
dc.contributor.authorSnelson, Catherine
dc.contributor.authorSpittle, Nick
dc.contributor.authorStaines, Nikki
dc.contributor.authorStambach, Tom
dc.contributor.authorStewart, Richard
dc.contributor.authorSubudhi, Pradeep
dc.contributor.authorSzakmany, Tamas
dc.contributor.authorTatham, Kate
dc.contributor.authorThomas, Jo
dc.contributor.authorThompson, Chris
dc.contributor.authorThompson, Robert
dc.contributor.authorTridente, Ascanio
dc.contributor.authorTupper-Carey, Darell
dc.contributor.authorTwagira, Mary
dc.contributor.authorUstianowski, Andrew
dc.contributor.authorVallotton, Nick
dc.contributor.authorVincent-Smith, Lisa
dc.contributor.authorVisuvanathan, Shico
dc.contributor.authorVuylsteke, Alan
dc.contributor.authorWaddy, Sam
dc.contributor.authorWake, Rachel
dc.contributor.authorWalden, Andrew
dc.contributor.authorWelters, Ingeborg
dc.contributor.authorWhitehouse, Tony
dc.contributor.authorWhittaker, Paul
dc.contributor.authorWhittington, Ashley
dc.contributor.authorPapineni, Padmasayee
dc.contributor.authorWijesinghe, Meme
dc.contributor.authorWilliams, Martin
dc.contributor.authorWilson, Lawrence
dc.contributor.authorWinchester, Stephen
dc.contributor.authorWiselka, Martin
dc.contributor.authorWolverson, Adam
dc.contributor.authorWootton, Daniel G
dc.contributor.authorWorkman, Andrew
dc.contributor.authorYates, Bryan
dc.contributor.authorYoung, Peter
dc.contributor.authorWai Ho, Antonia Ying
dc.date.accessioned2021-10-26T14:50:32Z
dc.date.available2021-10-26T14:50:32Z
dc.date.issued2021-10-22
dc.date.submitted2021-07-13
dc.identifier.otherbmjopen-2021-055435
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/329904
dc.description.abstractObjectives: The steroid hormone vitamin D has roles in immunomodulation and bone health. Insufficiency is associated with susceptibility to respiratory infections. We report 25-hydroxy vitamin D (25(OH)D) measurements in hospitalised people with COVID-19 and influenza A and in survivors of critical illness to test the hypotheses that vitamin D insufficiency scales with illness severity and persists in survivors. Design: Cross-sectional study. Setting and participants: Plasma was obtained from 295 hospitalised people with COVID-19 (International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)/WHO Clinical Characterization Protocol for Severe Emerging Infections UK study), 93 with influenza A (Mechanisms of Severe Acute Influenza Consortium (MOSAIC) study, during the 2009–2010 H1N1 pandemic) and 139 survivors of non-selected critical illness (prior to the COVID-19 pandemic). Total 25(OH)D was measured by liquid chromatography-tandem mass spectrometry. Free 25(OH)D was measured by ELISA in COVID-19 samples. Outcome measures: Receipt of invasive mechanical ventilation (IMV) and in-hospital mortality. Results: Vitamin D insufficiency (total 25(OH)D 25–50 nmol/L) and deficiency (<25 nmol/L) were prevalent in COVID-19 (29.3% and 44.4%, respectively), influenza A (47.3% and 37.6%) and critical illness survivors (30.2% and 56.8%). In COVID-19 and influenza A, total 25(OH)D measured early in illness was lower in patients who received IMV (19.6 vs 31.9 nmol/L (p<0.0001) and 22.9 vs 31.1 nmol/L (p=0.0009), respectively). In COVID-19, biologically active free 25(OH)D correlated with total 25(OH)D and was lower in patients who received IMV, but was not associated with selected circulating inflammatory mediators. Conclusions: Vitamin D deficiency/insufficiency was present in majority of hospitalised patients with COVID-19 or influenza A and correlated with severity and persisted in critical illness survivors at concentrations expected to disrupt bone metabolism. These findings support early supplementation trials to determine if insufficiency is causal in progression to severe disease, and investigation of longer-term bone health outcomes.
dc.languageen
dc.publisherBMJ Publishing Group
dc.rightsEmbargo: ends 2021-10-22
dc.subjectInfectious diseases
dc.subject1506
dc.subject2474
dc.subject1706
dc.subjectCOVID-19
dc.subjectintensive & critical care
dc.subjectrespiratory infections
dc.subjectimmunology
dc.titleVitamin D insufficiency in COVID-19 and influenza A, and critical illness survivors: a cross-sectional study
dc.typeArticle
dc.date.updated2021-10-26T14:50:30Z
prism.issueIdentifier10
prism.publicationNameBMJ Open
prism.volume11
dc.identifier.doi10.17863/CAM.77349
dcterms.dateAccepted2021-09-30
rioxxterms.versionofrecord10.1136/bmjopen-2021-055435
rioxxterms.versionVoR
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.licenseref.startdate2021-10-22
dc.contributor.orcidGriffith, David M [0000-0001-9500-241X]
dc.contributor.orcidSummers, Charlotte [0000-0002-7269-2873]
dc.contributor.orcidRussell, Clark D [0000-0002-9873-8243]
dc.identifier.eissn2044-6055
pubs.funder-project-idMedical Research Council (MC_PC_19059, MR/R005982/1)
pubs.funder-project-idNational Institute for Health Research (CS-2016-16-011)
pubs.funder-project-idWellcome (205228/Z/16/Z, 215091/Z/18/Z)
pubs.funder-project-idNational Institute for Health Research (NIHR) (CO-CIN-01)
rioxxterms.freetoread.startdate2021-10-22


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