Crit Care Med. 2011 Jan 14.
Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, Christopher KB.
From the Renal Division (AB, DC, KM, KBC), Brigham and Women's Hospital; Pulmonary Division (FKG), Massachusetts General Hospital; and Departments of Nutrition (YL, EG) and Epidemiology (EG), Harvard School of Public Health, Boston, MA.
OBJECTIVE: We hypothesized that deficiency in 25-hydroxyvitamin D before 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: A total of 209 medical and surgical intensive care beds in two teaching hospitals in Boston, MA.
PATIENTS: A total of 2,399 patients, age ?18 yrs, in whom 25-hydroxyvitamin D was measured before hospitalization between 1998 and 2009.
MEASUREMENTS AND MAIN RESULTS: Preadmission 25-hydroxyvitamin D was categorized as deficiency in 25-hydroxyvitamin D (?15 ng/mL), insufficiency (16-29 ng/mL), and sufficiency (?30 ng/mL). Logistic regression examined death by days 30, 90, and 365 post-intensive care unit admission, in-hospital mortality, and blood culture positivity. Adjusted odds ratios were estimated by multivariable logistic regression models.
Preadmission 25-hydroxyvitamin D deficiency is predictive for short-term and long-term mortality.
At 30 days following intensive care unit admission, patients with 25-hydroxyvitamin D deficiency have an odds ratio for mortality of 1.69 (95% confidence interval of 1.28-2.23, p < .0001) relative to patients with 25-hydroxyvitamin D sufficiency.
25-Hydroxyvitamin D deficiency remains a significant predictor of mortality at 30 days following intensive care unit admission following multivariable adjustment (adjusted odds ratio of 1.69, 95% confidence interval of 1.26-2.26, p < .0001).
At 30 days following intensive care unit admission, patients with 25-hydroxyvitamin D insufficiency have an odds ratio of 1.32 (95% confidence interval of 1.02-1.72, p = .036) and an adjusted odds ratio of 1.36 (95% confidence interval of 1.03-1.79, p = .029) relative to patients with 25-hydroxyvitamin D sufficiency.
Results were similar at 90 and 365 days following intensive care unit admission and for in-hospital mortality. In a subgroup analysis of patients who had blood cultures drawn (n = 1160), 25-hydroxyvitamin D deficiency was associated with increased risk of blood culture positivity. Patients with 25-hydroxyvitamin D insufficiency have an odds ratio for blood culture positivity of 1.64 (95% confidence interval of 1.05-2.55, p = .03) relative to patients with 25-hydroxyvitamin D sufficiency, which remains significant following multivariable adjustment (odds ratio of 1.58, 95% confidence interval of 1.01-2.49, p = .048).
CONCLUSION: Deficiency of 25-hydroxyvitamin D before 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. PMID: 21242800
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