Vitamin D level is associated with mortality predictors in ventilator-associated pneumonia caused by Acinetobacter baumannii

Abstract

Introduction: Vitamin D plays a role in host defense and is known to be associated with mortality in patients in the intensive care unit (ICU). We aimed to evaluate the relationships between vitamin D levels and predictors of mortality in patients with ventilator-associated pneumonia (VAP) caused by extensively drug-resistant Acinetobacter baumanii (XDR A. baumanii). Results: Forty-for patients were studied over six months. All patients had vitamin D deficiency. The 28-day mortality in patients with 25(OH)D levels ≤ 10 ng/mL was higher than in patients with 25(OH)D > 10ng/mL (p = 0.001). The fourth-and seventh-day SOFA scores (p= 0.04 and p= 0.001) and first-and fourth-day procalcitonin levels (p = 0.03 and p = 0.004) were higher in patients with 25(OH)D levels ≤ 10 ng/mL. The clinical scores (SOFA, CPIS, and CEPPIS) and biomarkers (NT-proBNP, PCT) were negatively correlated with 25(OH)D levels in all study groups. Conclusions: Severe vitamin D deficiency was associated with adverse outcome in VAP due to XDR A. baumanii. Vitamin D levels may be a prognostic predictor of VAP. It is also important to evaluate the effect of rapid vitamin D replacement on mortality.

Serum vitamin D level was not associated with severity of ventilator associated pneumonia

“…According to the study of Murat Haliloglu et al, they reported that the clinical scores (SOFA, CPIS, and CEPPIS) and biomarkers (NT-proBNP, PCT) were negatively correlated with 25(OH)D levels in all study groups. Unlike our study their results declared the 28-day mortality in patients with 25(OH)D levels ≤ 10 ng/mL was significantly higher than in patients with 25(OH)D > 10ng/mL, that may be related to their cut-off point (10ng/mL) [19]. Amrein et al demonstrated that critically ill patients with low PTH or serum calcium levels, as well as low 25(OH)D levels (cut-off 12 ng/mL) were all at significantly greater risk for all-cause mortality [20].…”

“…A study to investigate the association of baseline and synthetic vitamin D level, with mortality in critically ill inpatients in ICU, demonstrated that it was the same in patients with 25(OH) D deficiency and in those without such deficiency [17]. However, a study reported that SOFA Score on days 4 and 7 was higher in the group with serum 25(OH) D levels ≤ 10 than in another group [19]. As an index of predicting mortality of critically ill patients [26], SOFA Score can be influenced by several environmental and physiological factors, which may confound the findings of the current study.…”

Combating Multidrug-Resistant Pathogens with Host-Directed Nonantibiotic Therapeutics

“…From our screens against A. baumannii, calcitriol and calcipotriene, both of which are vitamin D supplements, were identified to control infection in macrophages. Interestingly, vitamin D deficiency has been linked to the development of A. baumannii infections and is a predictor of mortality in critically ill patients (54,55). In terms of its mechanism of action, vitamin D has been reported to induce the antimicrobial peptide LL-37, which can effectively kill both Gram-positive and Gram-negative pathogens as well as promote bacterial phagocytosis and killing by macrophages (56).…”

Risk factors for mortality in ICU patients with Acinetobacter baumannii ventilator-associated pneumonia: impact of bacterial cytotoxicity

“…Numerous and diverse underlying systemic diseases have been reported as potential risk factors for mortality in A. baumannii infection (19)(20)(21)(22)(23)(24). These include malignancy, post-transplantation status and chronic respiratory disease following previous survey.…”