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Abstract: Background: Vitamin D status is influenced by season, age, and public health messaging. The COVID-19 pandemic was accompanied by heightened interest in vitamin D, but long-term national data from Central/Eastern Europe remain limited. We aimed to characterize 10-year trends, seasonal variation, and demographic determinants of serum 25-hydroxyvitamin D [25(OH)D] in Slovenia, with particular focus on changes during the COVID-19 period. Methods: We performed a retrospective cross-sectional analysis of all serum 25(OH)D measurements performed at the Slovenian national reference laboratory between January 2014 and December 2023. The core analytic cohort included 106,875 patients with valid 25(OH)D results, aged 0–100 years. Vitamin D status was classified as deficient (<30 nmol/L), insufficient (30–50 nmol/L), adequate (50–75 nmol/L), and optimal (>75 nmol/L). Temporal trends, seasonal patterns, and age- and sex-specific differences were assessed using non-parametric tests and Kendall’s τ. Results: Mean 25(OH)D concentration over the study period was 61.9 ± 34.2 nmol/L; 16.0% of patients were deficient and 22.8% insufficient. Annual mean 25(OH)D increased from 57.0 nmol/L in 2014 to 67.2 nmol/L in 2023, with a significant upward temporal trend and a 14.6% higher mean level during 2020–2023 compared with 2014–2019. Seasonal variation was pronounced (≈20% higher summer–autumn vs. winter–spring), and vitamin D status declined progressively with age, with the highest deficiency prevalence in patients ≥ 70 years. Females had slightly higher 25(OH)D than males, although absolute differences were small. Conclusions: This laboratory-based analysis of tested patients showed higher 25(OH)D concentrations during and after the COVID-19 period, superimposed on persistent seasonal and age-related gradients. These observations identify older adults and winter testing periods as important contexts for vitamin D optimization, but they should be interpreted as descriptive trends among tested individuals rather than as evidence of causal pandemic effects or population-wide prevalence changes.
Keywords: 25-hydroxyvitamin D, seasonal variation, deficiency, age factors, COVID-19 pandemic
Published in DiRROS: 24.04.2026; Views: 174; Downloads: 106
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Abstract: Vitamin D deficiency is common in hospitalized COVID-19 patients and is associated with increased severity. However, single-biomarker approaches provide insufficient prognostic precision. We developed an integrative inflammatory-metabolic risk index combining vitamin D status, systemic inflammation, and coagulation activation. This is a prospective cohort study of 512 hospitalized COVID-19 patients (September 2022–December 2023) with serum 25(OH)D3 measurement at admission. The primary analysis (N = 301) included patients with complete data for VDIBS-Core components (CRP, ferritin, D-dimer, LDH). The Vitamin D Inflammatory Burden Score-Core (VDIBS-Core; range 0–7) integrated the following: (1) vitamin D tier (deficient < 30 nmol/L: 3 points; insufficient 30–50: 2; non-optimal 50–75: 1; sufficient > 75: 0), (2) inflammation score (CRP ≥ 100, ferritin ≥ 1000 each +1 point; 0–2 total), and (3) coagulation score (D-dimer ≥ 1000, LDH ≥ 3–6 or ≥ 6 each +0–2 points; 0–2 total). The IL-6 measurement (N = 48, 9.4%) was explored separately as VDIBS-Plus in the secondary analysis. The outcomes were severe COVID-19 (defined as the worst severity classification during hospitalization per WHO criteria), ICU admission, and mortality. The mean vitamin D was 63.4 ± 33.2 nmol/L (68.1% deficient). Among N = 301 with complete VDIBS-Core data, severe disease occurred in 221 (73.4%), ICU admission in 15 (5.0%), and mortality in 8 (2.7%). VDIBS-Core risk stratification showed the following: low-risk (VDIBS 0–2, n = 178) 8.4% severe; moderate-risk (VDIBS 3–5, n = 245) 45.7% severe; and high-risk (VDIBS 6–7, n = 89) 78.6% severe; χ2 = 142.3, p < 0.001. VDIBS-Core predicted severe disease with AUC 0.78 (95% CI 0.74–0.82), with excellent calibration (Hosmer–Lemeshow p = 0.40). When compared to complex multivariate models incorporating all seven individual biomarkers, VDIBS-Core demonstrated equivalent discrimination (AUC 0.82, Δ = 0.04, p = 0.08, not statistically significant) with superior clinical simplicity. Bootstrap internal validation confirmed modest optimism (optimism-corrected AUC 0.76). An incremental value analysis demonstrated that the vitamin D component contributes a significant additional predictive value compared to inflammation/coagulation biomarkers alone (LR test p = 0.004). VDIBS-Core provides bedside-implementable risk stratification using three simple components measurable in <5 min, integrating vitamin D-dependent immune regulation with systemic inflammation and coagulation activation. This composite approach offers a practical tool for treatment intensity escalation and monitoring frequency assignment in hospitalized COVID-19 patients. External validation in geographically diverse cohorts is required before widespread clinical implementation.
Keywords: vitamin D deficiency, COVID-19 severity, biomarker integration, risk stratification, immunometabolism
Published in DiRROS: 08.04.2026; Views: 167; Downloads: 100
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Abstract: The so-called “smoking paradox”, conditioning lower mortality in smokers among STEMI patients, has seldom been addressed in the settings of modern primary PCI protocols. The ISACS–STEMI COVID-19 is a large-scale retrospective multicenter registry addressing in-hospital mortality, reperfusion, and 30-day mortality among primary PCI patients in the era of the COVID-19 pandemic. Among the 16,083 STEMI patients, 6819 (42.3%) patients were active smokers, 2099 (13.1%) previous smokers, and 7165 (44.6%) non-smokers. Despite the impaired preprocedural recanalization (p < 0.001), active smokers had a significantly better postprocedural TIMI flow compared with non-smokers (p < 0.001); this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. Active smokers had a significantly lower in-hospital (p < 0.001) and 30-day (p < 0.001) mortality compared with non-smokers and previous smokers; this was confirmed after adjustment for all baseline and procedural confounders, and the propensity score. In conclusion, in our population, active smoking was significantly associated with improved epicardial recanalization and lower in-hospital and 30-day mortality compared with previous and non-smoking history.
Keywords: myocardial infarction, smoking paradox, percutaneous coronary intervention, COVID-19, mortality
Published in DiRROS: 31.03.2026; Views: 200; Downloads: 82
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Abstract: Background: Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclero‑ sis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocar‑ dial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods: In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with pri‑ mary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results: A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dis‑ similarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P=0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjust‑ ment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI]=0.913[0.658–1.266], P=0.585) nor for 30-days mortality (adjusted OR [95% CI]=0.850 [0.620–1.164], P=0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion: This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline charac‑ teristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity.
Keywords: COPD, STEMI, COVID-19
Published in DiRROS: 24.03.2026; Views: 247; Downloads: 147
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Abstract: Objectives: The SARS-CoV-2 pandemic was declared by World Health Organisation (WHO) in March 2020, causing health and economic disruptions and millions of deaths. Pregnant women represent a vulnerable group, as COVID-19 during pregnancy increases the risk of preterm birth, preeclampsia, and severe maternal illness. Nutritional status, such as vitamin D deficiency, may influence these outcomes, yet data on its status in the cohort of SARS-CoV-2 positive pregnant women as well as its association with inflammatory and angiogenic markers is scarce. The aim of this study was to evaluate the levels of vitamin D in the cohort of SARSCoV- 2 positive pregnant women and its association with inflammatory and angiogenic markers. Methods: Prospective cohort study at Ljubljana Maternity Hospital (Oct 1, 2020–Mar 30, 2021) enrolled singleton pregnancies with PCR-confirmed SARS-CoV-2 within the last 14 days, delivering at our institution. Results: Among 235 SARS-CoV-2-positive pregnant women 62.1% had adequate and 21.3% insufficient level of vitamin D and 13.6%were vitaminDdeficient. Statistical analysis revealed no significant correlations between 25-OH-vitamin D and Creactive protein (CRP), procalcitonin (PCT), leukocyte count, soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), the sFlt-1/PlGF ratio, or body mass index (BMI). Conclusions: Our prospective cohort study revealed that high proportion of pregnant women has inadequate levels of vitamin D. Although maternal insufficiency is linked to adverse outcomes, its association with inflammatory and angiogenic markers remains unclear. Rigorous studies in pregnancy are essential to clarify vitamin D’s role in COVID-19 complications in pregnancy.
Keywords: COVID-19, pandemic, pregnancy, SARS-CoV-2, vitamin D deficiency, inflammation
Published in DiRROS: 19.03.2026; Views: 248; Downloads: 176
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