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Giustina A, Uygur MM, Frara S, Barkan A, Biermasz NR, Chanson P, Freda P, Gadelha M, Kaiser UB, Lamberts S, Laws E, Nachtigall LB, Popovic V, Reincke M, Strasburger C, van der Lely AJ, Wass JAH, Melmed S, Casanueva FF. Pilot study to define criteria for Pituitary Tumors Centers of Excellence (PTCOE): results of an audit of leading international centers. Pituitary 2023; 26:583-596. [PMID: 37640885 PMCID: PMC10539196 DOI: 10.1007/s11102-023-01345-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The Pituitary Society established the concept and mostly qualitative parameters for defining uniform criteria for Pituitary Tumor Centers of Excellence (PTCOEs) based on expert consensus. Aim of the study was to validate those previously proposed criteria through collection and evaluation of self-reported activity of several internationally-recognized tertiary pituitary centers, thereby transforming the qualitative 2017 definition into a validated quantitative one, which could serve as the basis for future objective PTCOE accreditation. METHODS An ad hoc prepared database was distributed to nine Pituitary Centers chosen by the Project Scientific Committee and comprising Centers of worldwide repute, which agreed to provide activity information derived from registries related to the years 2018-2020 and completing the database within 60 days. The database, provided by each center and composed of Excel® spreadsheets with requested specific information on leading and supporting teams, was reviewed by two blinded referees and all 9 candidate centers satisfied the overall PTCOE definition, according to referees' evaluations. To obtain objective numerical criteria, median values for each activity/parameter were considered as the preferred PTCOE definition target, whereas the low limit of the range was selected as the acceptable target for each respective parameter. RESULTS Three dedicated pituitary neurosurgeons are preferred, whereas one dedicated surgeon is acceptable. Moreover, 100 surgical procedures per center per year are preferred, while the results indicated that 50 surgeries per year are acceptable. Acute post-surgery complications, including mortality and readmission rates, should preferably be negligible or nonexistent, but acceptable criterion is a rate lower than 10% of patients with complications requiring readmission within 30 days after surgery. Four endocrinologists devoted to pituitary diseases are requested in a PTCOE and the total population of patients followed in a PTCOE should not be less than 850. It appears acceptable that at least one dedicated/expert in pituitary diseases is present in neuroradiology, pathology, and ophthalmology groups, whereas at least two expert radiation oncologists are needed. CONCLUSION This is, to our knowledge, the first study to survey and evaluate the activity of a relevant number of high-volume centers in the pituitary field. This effort, internally validated by ad hoc reviewers, allowed for transformation of previously formulated theoretical criteria for the definition of a PTCOE to precise numerical definitions based on real-life evidence. The application of a derived synopsis of criteria could be used by independent bodies for accreditation of pituitary centers as PTCOEs.
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Affiliation(s)
- A Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Via Olgettina 60, 20132, Milan, Italy.
| | - M M Uygur
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Endocrinology and Metabolism Disease, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - S Frara
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - A Barkan
- Division of Endocrinology, University of Michigan Health System, Ann Arbor, MI, USA
| | - N R Biermasz
- Leiden University Medical Center, Center for Endocrine Tumors Leiden, Leiden, The Netherlands
| | - P Chanson
- Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, APHP, Hôpital Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction et Centre de Référence des Maladies Rares de l'Hypophyse HYPO, Le Kremlin-Bicêtre, Paris, France
| | - P Freda
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - M Gadelha
- Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - U B Kaiser
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - S Lamberts
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Laws
- Pituitary/Neuroendocrine Center, Brigham & Women's Hospital, Boston, MA, USA
| | - L B Nachtigall
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - V Popovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - M Reincke
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - C Strasburger
- Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - A J van der Lely
- Pituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J A H Wass
- Department of Endocrinology, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - S Melmed
- Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - F F Casanueva
- Division of Endocrinology, Santiago de Compostela University and Ciber OBN, Santiago, Spain
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Pivonello R, Scaroni C, Polistena B, Migliore A, Giustina A. Unmet needs on the current medical management of Cushing's syndrome: results from a Delphi panel of Italian endocrinologists. J Endocrinol Invest 2023:10.1007/s40618-023-02058-8. [PMID: 37076758 PMCID: PMC10115381 DOI: 10.1007/s40618-023-02058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/02/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Cushing's syndrome (CS) is a rare clinical condition caused by excessive cortisol secretion from adrenal glands. CS is associated with increased mortality and morbidity; therefore, a prompt diagnosis and an effective therapeutic approach are strongly necessary to improve the patient's clinical management. The first-line treatment for CS is surgery, while medical treatment has historically played a minor role. However, thanks to the availability of novel compounds, the possibility of improving hypercortisolism control using different drug combinations emerged. PURPOSE No absolute recommendations are available to guide the therapeutic choice for patients with CS and, consequently, the awareness of unmet needs in CS management is growing. Although new data from clinical trials are needed to better define the most appropriate management of CS, an expert consensus approach can help define unmet needs and optimize the current CS management and treatment. METHODS Twenty-seven endocrinologists from 12 Italian regions, working among the main Italian referral centers for hospital endocrinology where they take care of CS patients, were involved in a consensus process and used the Delphi method to reach an agreement on 24 statements about managing CS patients. RESULTS In total, 18 statements reached a consensus. Some relevant unmet needs in the management of CS were reported, mainly related to the lack of a pharmacological treatment successful for the majority of patients. CONCLUSION While acknowledging the difficulty in achieving complete disease control, a significant change in CS management requires the availability of medical treatment with improved efficacy and safety over available therapeutic options at the time of the current study.
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Affiliation(s)
- R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - C Scaroni
- Endocrinology Unit, Department of Medicine, DIMED, Hospital-University of Padova, Padua, Italy
| | | | | | - A Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
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Nieto de la Marca MDLO, Díaz-Soto G, Sánchez Ibáñez M, Del Amo Simón S, Fernández Velasco P, Torres Torres B, López Gómez JJ, Gómez Hoyos E, Ortolá Buigues A, Delgado García E, de Luis Román D. Metabolic control and satisfaction in a diabetes education programme in flash glucose monitoring through telemedicine in type 1 diabetes. ENDOCRINOL DIAB NUTR 2022:S2530-0180(22)00198-6. [PMID: 36456461 DOI: 10.1016/j.endien.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate metabolic control and satisfaction with a telemedicine diabetes education programme for the initiation of flash glucose monitoring (FGM) in type 1 diabetes. MATERIAL AND METHODS Prospective study in 48 patients (52.1% women, 22.9% on insulin pump) who started FGM. They were analysed at baseline and 3 months after the beginning of the FGM. The results were compared with an on-site learning cohort matched by age, sex and HbA1c. RESULTS At the beginning and 3 months after the MFG, HbA1c improvement was observed (7.9±1.4 vs 7.3±1.1%), p<0.01; with a decrease in time below range - TBR - (4.7±4.9 vs 3.5±3.5%), p<0.05 and number of hypoglycaemic events (9.4±8.7 vs 6.9±5.7/15 days), p<0.05, associated with a worsening in time above range - TAR - (33.5±19.9 vs 37.0±20.9%), p<0.05. No significant differences were observed in the TIR 70-180mg/dl (61.7±18.6 vs 59.4±20.0%), glycemic variability or the use of FGM. Patient satisfaction with telemedicine training was 4.8±0.3 out of 5. No significant differences were observed in the follow-up, either in HbA1c or other glucometer parameters between on-site and online training. In a multivariate analysis adopting the HbA1c at follow-up as the dependent variable, only the TIR (β=-0.034; p<0.001) and the initial HbA1c (β=0.303; p<0.001) maintained statistical significance, unrelated to the on-site or online training (β=0.136; p=ns). CONCLUSIONS A telemedicine programme is an adequate tool for training in FGM, with results similar to on-site training, and it was associated with a high degree of satisfaction.
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Affiliation(s)
- María de la O Nieto de la Marca
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain.
| | - Gonzalo Díaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Marta Sánchez Ibáñez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Sofía Del Amo Simón
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Pablo Fernández Velasco
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Beatriz Torres Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Juan José López Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Emilia Gómez Hoyos
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Ana Ortolá Buigues
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Esther Delgado García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
| | - Daniel de Luis Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina Valladolid, Valladolid, Spain
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di Filippo L, Frara S, Doga M, Giustina A. The osteo-metabolic phenotype of COVID-19: an update. Endocrine 2022; 78:247-254. [PMID: 35857271 PMCID: PMC9297261 DOI: 10.1007/s12020-022-03135-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022]
Abstract
CONTEXT In the multifaceted COVID-19 clinical scenario characterized by a multi-system disorder with negative implications not only on respiratory function but also on cardiac, hematological, neurological and endocrine-metabolic systems, a distinctive osteo-metabolic phenotype with an independent influence on disease severity and recovery of patients affected was early reported. AIM To summarize and update the main evidences regarding the distinct components of this phenotype in acute and Long COVID-19, reinforcing its clinical relevance and discussing the main pathophysiological and clinical-therapeutic implications of the most recent reported findings. RESULTS This emerging phenotype is characterized by a widespread acute hypocalcemia and hypovitaminosis D with an impaired compensatory parathyroid hormone response, and a high prevalence of skeletal complications such as vertebral fractures. The clinical relevance of this osteo-metabolic phenotype on acute COVID-19 is well characterized, and novel seminal evidences are progressively highlighting its importance also in predicting patient's long-term outcomes and Long COVID-19 occurrence. CONCLUSIONS These findings reinforced the central role of a multidisciplinary team, including endocrinologists, in evaluating these patients for a proactive search of each aspect of the osteo-metabolic phenotype components since they may represent suitable therapeutic targets to prevent SARS-CoV-2 infection, poor COVID-19 outcomes, Long COVID-19 occurrence and even possibly better responses to COVID-19 vaccination.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mauro Doga
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy.
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di Filippo L, Compagnone N, Frara S, Allora A, Doga M, Rovere Querini P, Cremona G, Giustina A. Vertebral fractures at hospitalization predict impaired respiratory function during follow-up of COVID-19 survivors. Endocrine 2022; 77:392-400. [PMID: 35676466 DOI: 10.1007/s12020-022-03096-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Morphometric vertebral fractures (VFs) have been recently reported as an important component of the endocrine phenotype of COVID-19 and emerging data show negative respiratory sequelae at long-term follow-up in COVID-19 survivors. The aim of this study was to evaluate the impact of VFs on respiratory function in COVID-19 survivors. METHODS We included patients referred to our Hospital Emergency Department and re-evaluated during follow-up. VFs were detected on lateral chest X-rays on admission using a qualitative and semiquantitative assessment and pulmonary function tests were obtained by Jaeger-MasterScreen-Analyzer Unit 6 months after discharge. RESULTS Fifty patients were included. Median age was 66 years and 66% were males. No respiratory function data were available at COVID-19 diagnosis. VFs were detected in 16 (32%) patients. No differences between fractured and non-fractured patients regarding age and sex were observed. Although no difference was observed between VF and non-VF patient groups in the severity of pneumonia as assessed by Radiological-Assessment-of-Lung-Edema score at admission, (5 vs. 6, p = 0.69), patients with VFs were characterized as compared to those without VFs by lower Forced Vital Capacity (FVC, 2.9 vs. 3.6 L, p = 0.006; 85% vs. 110% of predicted, respectively, p = 0.001), Forced Expiratory Volume 1st s (FEV1, 2.2 vs. 2.8 L, p = 0.005; 92% vs. 110% of predicted, respectively, p = 0.001) and Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO 5.83 vs. 6.98 mmol/min/kPa, p = 0.036, 59% vs. 86.3% of predicted, respectively, p = 0.043) at 6-month follow up. CONCLUSIONS VFs, expression of the endocrine phenotype of the disease, appear to influence medium-term impaired respiratory function of COVID-19 survivors which may significantly influence their recovery. Therefore, our findings suggest that a VFs assessment at baseline may help in identifying patients needing a more intensive respiratory follow-up and patients showing persistent respiratory impairment without evidence of pulmonary disease may benefit from VFs assessment to preventing the vicious circle of further fractures and respiratory deterioration.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Compagnone
- Division of Transplantation, Immunology and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Agnese Allora
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mauro Doga
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Rovere Querini
- Division of Transplantation, Immunology and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - George Cremona
- Unit of Respiratory Medicine, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
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Nieto de la Marca MDLO, Díaz-Soto G, Sánchez Ibáñez M, del Amo Simón S, Fernández Velasco P, Torres Torres B, López Gómez JJ, Gómez Hoyos E, Ortolá Buigues A, Delgado García E, de Luis Román D. Control metabólico y satisfacción de un programa de educación diabetológica en monitorización flash de glucosa mediante telemedicina en diabetes tipo 1. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Giustina A, Bilezikian JP. Revisiting the endocrine and metabolic manifestations of COVID-19 two years into the pandemic. Rev Endocr Metab Disord 2022; 23:133-136. [PMID: 35182326 PMCID: PMC8857394 DOI: 10.1007/s11154-022-09716-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/12/2022]
Abstract
An extraordinary effort of the universal endocrine community has led to important insights into endocrine and metabolic aspects of COVID-19. In this Editorial, we introduce a special issue of Reviews in Endocrine and Metabolic Disorders that calls attention, through the efforts of internationally recognized experts in the field, to features that are now widely recognized as endocrine and metabolic manifestations of COVID-19. These advances in our knowledge have seminal implications for how we can prevent and manage these aspects of COVID-19.
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Affiliation(s)
- A Giustina
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milano, Italy.
| | - J P Bilezikian
- Unit of Metabolic Bone Diseases, Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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di Filippo L, Castellino L, Giustina A. Occurrence and response to treatment of Graves' disease after COVID vaccination in two male patients. Endocrine 2022; 75:19-21. [PMID: 34727295 PMCID: PMC8561079 DOI: 10.1007/s12020-021-02919-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/16/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Laura Castellino
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, San Raffaele Vita-Salute University and IRCCS Hospital, Milan, Italy.
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di Filippo L, Allora A, Doga M, Formenti AM, Locatelli M, Rovere Querini P, Frara S, Giustina A. Vitamin D Levels Are Associated With Blood Glucose and BMI in COVID-19 Patients, Predicting Disease Severity. J Clin Endocrinol Metab 2022; 107:e348-e360. [PMID: 34383926 PMCID: PMC8385994 DOI: 10.1210/clinem/dgab599] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Indexed: 12/15/2022]
Abstract
CONTEXT A high prevalence of vitamin D (VD) deficiency in COVID-19 patients has been reported and hypothesized to increase COVID-19 severity likely because of its negative impact on immune and inflammatory responses. Furthermore, clear associations between hypovitaminosis D and fat body mass excess and diabetes, factors associated with COVID-19 severity, have been widely recognized. OBJECTIVE The aim of this study was to evaluate in COVID-19 patients the relationship between VD levels and inflammatory response, body mass index (BMI), blood glucose (GLU), and disease severity. METHODS Patients admitted to San Raffaele-Hospital for COVID-19 were enrolled in this study, excluding those with comorbidities and therapies influencing VD metabolism. 25-Hydroxyvitamin D levels, plasma GLU levels, BMI, and inflammatory parameters were evaluated at admission. RESULTS A total of 88 patients were included. Median VD level was 16.3 ng/mL and VD deficiency was found in 68.2% of patients. VD deficiency was found more frequently in male patients and in those affected by severe COVID-19. Regression analyses showed a positive correlation between VD and PaO2/FiO2 ratio, and negative correlations between VD and plasma GLU, BMI, neutrophil/lymphocyte ratio, C-reactive protein, and interleukin 6. Patients with both hypovitaminosis D and diabetes mellitus, as well those with hypovitaminosis D and overweight, were more frequently affected by a severe disease with worse inflammatory response and respiratory parameters, compared to those without or just one of these conditions. CONCLUSION We showed, for the first-time, a strict association of VD levels with blood GLU and BMI in COVID-19 patients. VD deficiency might be a novel common pathophysiological mechanism involved in the detrimental effect of hyperglycemia and adiposity on disease severity.
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Affiliation(s)
- Luigi di Filippo
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Agnese Allora
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Mauro Doga
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Anna Maria Formenti
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Locatelli
- Laboratory Medicine Service, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrizia Rovere Querini
- Vita-Salute San Raffaele University and Division of Transplantation, Immunology and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
- Correspondence: Prof. Andrea Giustina, Division of Endocrinology, IRCCS San Raffaele Hospital, via Olgettina 60, 20132 Milano, Italy;
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