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Hospital or ICU death about twice as likely if low vitamin D – March 2014

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

Crit Care. 2014 Mar 24;18(2):R47. [Epub ahead of print]
Amrein K, Zajic P, Schnedl C, Waltensdorfer A, Fruhwald S, Holl A, Urbanic Purkart T, Wünsch G, Valentin T, Grisold A, Stojakovic T, Amrein S, Pieber TR, Dobnig H.

INTRODUCTION:
Vitamin 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.

METHODS:
In a single-center retrospective observational study at a tertiary care center in Graz, Austria, 655 surgical and non-surgical 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.

RESULTS:
Overall, 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) 1.31-3.22) and
  • intermediate (HR 1.92, 95% CI 1.21-3.06) 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).

CONCLUSIONS:
Low 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.

PMID: 24661739

Seasonal variation in Vitamin D levels

http://vitamindwiki.com/tiki-index.php?page_id=5466
VitaminDWiki comment: Looks like 30% of Austrians who went to hosptial Nov-March previously took suncations or Vitmamin D supplements

Hosptial survival

http://vitamindwiki.com/tiki-index.php?page_id=5466

ICU survival

http://vitamindwiki.com/tiki-index.php?page_id=5466


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See also VitaminDWiki

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4019 Sepsis critical care.pdf PDF 2014 admin 07 Jun, 2014 12:13 2.79 Mb 390
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