Common variable immunodeficiency (CVID) is an inborn error of immunity characterized by impaired antibody production, poor vaccine responses, and reduced serum immunoglobulin levels. These immune defects commonly produce respiratory manifestations that can progress to chronic pulmonary complications. Prior studies in other populations have linked vitamin D status with pulmonary outcomes, but the relationship between serum 25-hydroxyvitamin D (25[OH]D) concentrations and specific pulmonary manifestations in CVID — particularly atelectasis — remained unclear.
This study aimed to assess whether 25(OH)D sufficiency is associated with differences in pulmonary outcomes among adults with CVID using available clinical and imaging data.
The investigators conducted a retrospective cross-sectional analysis of adult patients diagnosed with CVID. A total of 48 patients were included in the dataset. Demographic details beyond age categories (adult, middle aged) and sex descriptors are indexed in the source MeSH terms, but the abstract reports the overall sample size and stratification by vitamin D status only.
Patients were stratified by serum 25(OH)D concentration using a threshold of 30 ng/mL: values below 30 ng/mL were classified as insufficient, and values of 30 ng/mL or greater were classified as sufficient.
Pulmonary outcomes were obtained from patients' medical records and imaging reports. The recorded outcomes included:
The primary comparison assessed the prevalence of these outcomes between the 25(OH)D insufficient and sufficient groups.
Associations between 25(OH)D status and categorical pulmonary outcomes were evaluated using Fisher's exact test. The authors also performed exploratory analyses that included a longitudinal imaging review and descriptive Kaplan-Meier curves illustrating atelectasis-free disease duration stratified by baseline 25(OH)D status. The Kaplan-Meier curves were descriptive and intended to illustrate possible time-to-event differences rather than provide definitive survival-analysis conclusions.
Among the 48 CVID patients, 35 (73%) had serum 25(OH)D concentrations below 30 ng/mL (insufficient). Atelectasis was significantly more frequent in the insufficient group: 15 of 35 patients (43%) in the insufficient group had atelectasis. The reported association corresponded to an odds ratio of 0.12 (95% confidence interval, 0.01–0.97) with a P value of 0.02, indicating a statistically significant lower prevalence of atelectasis among patients with 25(OH)D sufficiency compared with insufficiency in this cross-sectional sample.
No statistically significant associations were observed between baseline 25(OH)D status and the other pulmonary outcomes recorded:
These results indicate that within the sample and methods used, 25(OH)D sufficiency was not associated with differences in prevalence for bronchiectasis, recurrent pneumonia, or COPD.
The exploratory Kaplan-Meier curves for atelectasis-free disease duration did not demonstrate an apparent separation between the groups, as reported in the abstract.
The authors conclude that serum 25(OH)D sufficiency was associated with a lower prevalence of atelectasis among adults with CVID in this cross-sectional cohort. Important caveats noted in the report include:
The authors recommend prospective studies to further evaluate the relationship between 25(OH)D status and atelectasis in CVID and to clarify whether vitamin D sufficiency may influence pulmonary outcomes or represents a marker linked to other risk modifiers.
These results support an association between serum 25(OH)D sufficiency and lower atelectasis prevalence in this CVID cohort but cannot determine causation. Prospective, adequately powered studies are needed to confirm and clarify these findings.