Summary of findings 1. Summary of Findings Table ‐ Vitamin D compared to placebo or standard care alone for individuals with moderate to severe disease.
| Vitamin D compared to placebo or standard care alone for individualswith moderate to severe disease | ||||||
| Patient or population: individualswith moderate to severe disease Setting: Inpatient Intervention: Vitamin D Comparison: placebo or standard care alone | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo or standard care alone | Risk with Vitamin D | |||||
| All‐cause mortality at hospital discharge | Two studies reported all cause‐mortality at hospital discharge but were to heterogenous to be pooled. One study reported that 0/50 participants in the vitamin D and 2/26 participants in the control group died [RR 0.11 (95% CI 0.01 to 2.13)]. The other study reported that 9/119 participants in the vitamin D and 6/118 participants in the placebo group died [RR 1.49 (95% CI 0.55 to 4.05)]. | 313 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW a,b,c | We are uncertain whether vitamin D supplementation increases or decreases all‐cause mortality. | ||
| Improvement of clinical status assessed with: liberation from supplemental oxygen support (for the subgroup of participants requiring any supplemental oxygen or ventilator support at baseline, i.e WHO≥5), and weaning or liberation from invasive mechanical ventilation (for the subgroup of participants requiring invasive mechanical ventilationat baseline, i.e WHO≥7) | 0 per 1,000 | 0 per 1,000 (0 to 0) | not estimable | ( studies) | ‐ | No study reported this outcome. |
| Worsening of clinical status assessed with: need for invasive mechanical ventilation (for the subgroup of participants not requiring invasive mechanical ventilationat baseline, i.e WHO≤6) | 144 per 1,000 | 75 per 1,000 (35 to 163) | RR 0.52 (0.24 to 1.13) | 237 (1 RCT) | ⊕⊕⊝⊝ LOW d | Vitamin D supplementation may decrease the need for mechanical ventilation, but the evidence is uncertain. |
| Quality of life, including fatigue and neurological status assessed with: standardised scales (e.g. WHOQOL‐100) up to longest follow‐up | 0 per 1,000 | 0 per 1,000 (0 to 0) | not estimable | ( studies) | ‐ | No study reported this outcome. |
| Adverse events (any grade) | Low | RR 2.98 (0.12 to 72.30) | 237 (1 RCT) | ⊕⊝⊝⊝ VERY LOW d,e | We do not know whether vitamin D supplementation is associated with a higher risk of adverse events. | |
| 3 per 1,000 | 8 per 1,000 (0 to 204) | |||||
| Serious adverse events | 0 per 1,000 | 0 per 1,000 (0 to 0) | not estimable | ( studies) | ‐ | No study reported this outcome. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
| See interactive version of this table: https://gdt.gradepro.org/presentations/#/isof/isof_question_revman_web_424522142738901140. | ||||||
a. Downgraded one level for serious study limitations, because of some concerns about risk of bias in one study. b. Downgraded two levels for very serious inconsistency, because of inconsistent directions and variations of point estimates. c. Downgraded two levels for very serious imprecision, because of wide confidence intervals, few participants, and few events. d. Downgraded two levels for very serious imprecision, because of only one study, wide confidence intervals, few participants, and few events. e. Downgraded one level for serious indirectness, because the reported outcome did not match our outcome definition.