Low vitamin D level is an independent predictor of poor outcomes in Clostridium difficile-associated diarrhea

Abstract

Background: The incidence, recurrence, and all-cause mortality rate for Clostridium difficileassociated diarrhea (CDAD) has increased markedly over the past 10 years despite treatment. Low vitamin D levels are known to impair immune responses to infection and are associated with increased mortality. We compared the role of patient comorbidity measured by the Charlson Comorbidity Index (CCI) with vitamin D levels to ascertain whether vitamin D levels were an independent variable affecting the outcome of CDAD or a marker of overall comorbidity. Methods: A prospective cohort study studied 62 patients hospitalized between 2008 and 2009 with manifestations of CDAD and a positive C. difficile toxin assay. All patients received standard antibiotics (metronidazole and/or vancomycin). Their status at 30-day follow up was classified as resolved or recurred/expired. Patients' CCI was calculated using their medical history. Logistic regression analysis of variables including 25-hydroxyvitamin D, CCI, age, gender, white blood cell count (WBC), albumin and residence type were performed. Results: There were 62 patients (43.6% men, 56.4% women) with CDAD; mean age was 75 ± 17 years. At 30-day follow up, 28 (45.2%) expired, 10 (16.1%) had persistent or recurrent diarrhea and 24 (38.7%) resolved. Nonresolution was seen in 38 (61.3%). There was no significant association between 30-day resolution status and CCI, gender, WBC, albumin level or residence type. Two variables were found to be independent predictors of resolution of CDAD: normal vitamin D levels (p = 0.028) and age <70 years (p = 0.024). Subjects with low vitamin D were 4.75 times more likely to fail to resolve CDAD than subjects with normal Vitamin D. Conclusion: In this study, vitamin D level and age are independent predictors of CDAD resolution in hospitalized patients. Low vitamin D levels and age >70 years old are associated with increased likelihood of recurrence. Low vitamin D levels are not a marker of comorbidity or advanced age.

Higher plasma vitamin D is associated with reduced risk of Clostridium difficile infection in patients with inflammatory bowel diseases

“…Wang et al . similarly demonstrated that individuals with CDI who were deficient in vitamin D were less likely to resolve infection 36 , consistent with data from van der Wilden et al . who demonstrated an inverse correlation between severity of CDI and plasma vitamin D levels 35 .…”

“…A few recent studies have examined this association between vitamin D levels and CDI in non-IBD cohorts 33–36 . In a study from the Veterans affairs population, Youssef et al .…”

25‐Hydroxyvitamin D Concentrations and Clostridium difficile Infection: A Meta‐Analysis

“…One possible explanation for this finding may be differences in the duration of follow‐up time used by the researchers. For instance, when CDI recurrence was defined as “within 30 days,” Arramraju et al 12 and Wang et al 13 found a significant association between lower 25(OH)D status and recurrence; however, when CDI recurrence was evaluated in a longer follow‐up period of 56 and 90 days, Abdelfatah et al 5 and Wong et al 16 did not find an association. We must point out, however, that study considerations may have had a role in this discrepancy.…”

Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort

“…In another study, it was shown that patients >70 years of age given vitamin D supplementation consumed less antibiotics (50% reduction) compared to the placebo group . Hypovitaminosis D (<50 nmol L −1 ) has been reported to be an independent predictor of nonresolution of clostridium difficile‐associated diarrhoea . Individuals with chronic pulmonary disease are reported to have significantly more exacerbations in the presence of hypovitaminosis D .…”