Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill*

Abstract

Objective We hypothesized that deficiency in 25-hydroxy vitamin D (25(OH)D) prior to hospital admission would be associated with all cause mortality in the critically ill. Design Multicenter observational study of patients treated in medical and surgical intensive care units. Setting 209 medical and surgical intensive care beds in two teaching hospitals in Boston, Massachusetts Patients 2,399 patients, age ≥ 18 years, in whom 25(OH)D was measured prior to hospitalization between 1998 and 2009. Measurements Pre-admission 25(OH)D was categorized as deficiency in 25(OH)D (≤15ng/mL), insufficiency (16–29ng/mL) and sufficiency (≥30ng/mL). Logistic regression examined death by days 30, 90 and 365 post-ICU admission, in hospital mortality and blood culture positivity. Adjusted odds ratios were estimated by multivariable logistic regression models. Interventions None Key Results Pre-admission 25(OH)D deficiency is predictive for short term and long term mortality. 30 days following ICU admission, patients with 25(OH)D deficiency have an OR for mortality of 1.69(95%CI, 1.28–2.23;P<.0001) relative to patients with 25(OH)D sufficiency. 25(OH)D deficiency remains a significant predictor of mortality at 30 days following ICU admission following multivariable adjustment (adjusted OR 1.69; 95%CI, 1.26–2.26;P<.0001). 30 days following ICU admission, patients with 25(OH)D insufficiency have an OR of 1.32(95%CI, 1.02–1.72; P=0.036) and an adjusted OR of 1.36(95%CI, 1.03–1.79;P=0.029) relative to patients with 25(OH)D sufficiency. Results were similar at 90 and 365 days following ICU admission and for in hospital mortality. In a subgroup analysis of patients who had blood cultures drawn (n=1,160), 25(OH)D deficiency was associated with increased risk of blood culture positivity. Patients with 25(OH)D insufficiency have an OR for blood culture positivity of 1.64(95%CI, 1.05–2.55;P=0.03) relative to patients with 25(OH)D sufficiency which remains significant following multivariable adjustment: OR 1.58(95%CI, 1.01–2.49;P=0.048). Conclusion Deficiency of 25(OH)D prior to hospital admission is a significant predictor of short and long term all cause patient mortality and blood culture positivity in a critically ill patient population.

Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

“…In 2399 patients, vitamin D deficiency up to 365 days before admission was a significant predictor of both short-and long-term mortality and of blood cultures positive for growth of microorganisms. 15 Significantly more (P < .01) patients in the vitamin D deficient group (30.3%) had a diagnosis of sepsis at admission than did patients who had insufficient (24%) or sufficient (19.4%) levels of the vitamin. 15 In a study 14 of 1325 patients, vitamin D deficiency within 7 days of ICU admission was a significant predictor of all-cause mortality.…”

“…15 Significantly more (P < .01) patients in the vitamin D deficient group (30.3%) had a diagnosis of sepsis at admission than did patients who had insufficient (24%) or sufficient (19.4%) levels of the vitamin. 15 In a study 14 of 1325 patients, vitamin D deficiency within 7 days of ICU admission was a significant predictor of all-cause mortality. In that study 14 the incidence of sepsis was significantly greater (P < .01) in patients with vitamin D deficiency (37.3%) than in patients with insufficient (28.6%) or sufficient (22.1%) levels of the vitamin.…”

“…Previous studies 14,15,29 have shown that vitamin D deficiency is associated with increased mortality in critically ill patients. In 2399 patients, vitamin D deficiency up to 365 days before admission was a significant predictor of both short-and long-term mortality and of blood cultures positive for growth of microorganisms.…”

“…Vitamin D deficiency (serum level of 25-hydroxyvitamin D ≤ 15 ng/mL; to convert to nanomoles per liter, multiply by 2.496) has been reported in 27% to 50% of intensive care unit (ICU) patients, and vitamin D insufficiency (15-30 ng/mL) has been reported in 38% of critically ill patients. 14,15 In a small cohort of ICU patients, 17% had undetectable levels of vitamin D. 16 In 2 recent studies, 14,15 a serum level of 25-hydroxyvitamin D less than 15 ng/mL in the year preceding hospital admission and within 7 days of ICU admission was independently associated with increased mortality. Furthermore, these studies indicated that 25-hydroxyvitamin D deficiency (defined as a serum level <15 ng/mL) before hospital admission was a significant predictor of sepsis in the critically ill, and patients with sepsis whose 25-hydroxyvitamin D level before admission was less than 30 ng/mL had increased risk for mortality after the ICU admission.…”

Diagnostic Value of 25-Hydroxyvitamin D Level and New Cytokines in Neonatal Sepsis

“…The major function of vitamin D is to maintain calcium and phosphorus homeostasis and bone mineralization, but currently there are many new studies focusing on the novel effects of the vitamin, such as glucose metabolism, endothelial functions and immune modulation (2,3). Especially, immune modulation effect of vitamin D has been studied recently in many studies related to sepsis (4,5).…”