Vitamin D status and its association with season, hospital and sepsis mortality in critical illness

Abstract

IntroductionVitamin D plays a key role in immune function. Deficiency may aggravate the incidence and outcome of infectious complications in critically ill patients. We aimed to evaluate the prevalence of vitamin D deficiency and the correlation between serum 25-hydroxyvitamin D (25(OH) D) and hospital mortality, sepsis mortality and blood culture positivity.MethodsIn a single-center retrospective observational study at a tertiary care center in Graz, Austria, 655 surgical and nonsurgical critically ill patients with available 25(OH) D levels hospitalized between September 2008 and May 2010 were included. Cox regression analysis adjusted for age, gender, severity of illness, renal function and inflammatory status was performed. Vitamin D levels were categorized by month-specific tertiles (high, intermediate, low) to reflect seasonal variation of serum 25(OH) D levels.ResultsOverall, the majority of patients were vitamin D deficient (<20 ng/ml; 60.2%) or insufficient (≥20 and <30 ng/dl; 26.3%), with normal 25(OH) D levels (>30 ng/ml) present in only 13.6%. The prevalence of vitamin D deficiency and mean 25(OH) D levels was significantly different in winter compared to summer months (P <0.001). Hospital mortality was 20.6% (135 of 655 patients). Adjusted hospital mortality was significantly higher in patients in the low (hazard ratio (HR) 2.05, 95% confidence interval (CI) 1.31 to 3.22) and intermediate (HR 1.92, 95% CI 1.21 to 3.06) compared to the high tertile. Sepsis was identified as cause of death in 20 of 135 deceased patients (14.8%). There was no significant association between 25(OH) D and C-reactive protein (CRP), leukocyte count or procalcitonin levels. In a subgroup analysis (n = 244), blood culture positivity rates did not differ between tertiles (23.1% versus 28.2% versus 17.1%, P = 0.361).ConclusionsLow 25(OH) D status is significantly associated with mortality in the critically ill. Intervention studies are needed to investigate the effect of vitamin D substitution on mortality and sepsis rates in this population.

Low levels of vitamin D are associated with nosocomial infections but not with short-term mortality in critically ill patients

“…We observed a higher incidence of 25 (OH) D deficiency in critically ill patients than previously reported (10)(11)(12)(13)(14)(15)(16)(17)(23)(24)(25). However, most of these studies were from developed countries.…”

Vitamin D deficiency in the critically ill

“…This may result in even lower ''vitamin D levels'' as serum 25(OH)D is the accepted marker for vitamin D status. Several studies report low vitamin D levels to be a biomarker associated with sepsis severity, organ dysfunction and even mortality in critically ill patients (18)(19)(20)(21)(22)(23)(24).…”

Vitamin D in critically ill patients

“…The findings, reported by Amrein and colleagues [32], have revealed that the vast majority (87%) of ICU patients had low or very low concentrations of vitamin D, which was positively correlated with mortality. The study carried out by Venkatram and colleagues [33] demonstrated a correlation between the concentration of 25(OH)D in patients in a multi-specialized ICU and hospital mortality.…”