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Purpose We aimed to assess the combined role of vitamin D and albumin serum levels as predictors of COVID-19 disease progression. Methods We conducted a prospective observational study on adult patients hospitalized for SARS-CoV-2 pneumonia (March–September 2020). Vitamin D and albumin serum levels were measured on admission. These variables were categorized in albumin &lt; 3.5 or ≥ 3.5 g/dL and vitamin D &lt; 30 ng/mL or ≥ 30 ng/mL. We excluded patients with known bone diseases, renal failure, hypercalcemia and/or treated with antiepileptic drugs and steroids, and patients who received previous vitamin D supplementation. A composite outcome including any ventilatory support, PaO 2 /FiO 2  ratio, and 60-day mortality was defined. Results Sixty-nine patients were enrolled, of whom 50% received non-invasive (NIV) or invasive mechanical ventilation (IMV), 10% died, whereas 89% and 66% presented low albumin and low vitamin D serum levels, respectively. No correlation between vitamin D and albumin levels was found. In multivariable logistic regression analyses adjusted for sex and age-corrected comorbidities, patients having albumin &lt; 3.5 g/dL and vitamin D &lt; 30 ng/mL showed a significant increased risk for all study outcomes, namely NIV/IMV ( OR  3.815; 95%  CI  1.122–12.966;  p  = 0.032), NIV/IMV or death ( OR  3.173; 95%  CI  1.002–10.043;  p  = 0.049) and PaO 2 /FIO 2  ≤ 100 ( OR  3.410; 95%  CI  1.138–10.219;  p  = 0.029). Conclusion The measurement of both vitamin D and serum albumin levels on COVID-19 patients’ admission, and their combined evaluation, provides a simple prognostic tool that could be employed to guide prompt clinical decisions.

A combined role for low vitamin D and low albumin circulating levels as strong predictors of worse outcome in COVID-19 patients