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.
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.
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.
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).
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.
VitaminDWiki comment: Looks like 30% of Austrians who went to hosptial Nov-March previously took suncations or Vitmamin D supplements
PDF is attached at the bottom of this page
- More sepsis deaths in those entering hospital with low vitamin D – Jan 2014
- 6 percent less likely to die by taking just a little vitamin D for 3 plus years – RCT Dec 2013
- Chance of dying within 1 month of entering hospital is 45 percent higher if low vitamin D – July 2013 death after leaving ICUl is ofte ignored
- 3X more likely to die within 3 months of being in ICU for 2 days if less than 20 ng vitamin D – Sept 2013
- Plasma exchange cut vitamin D levels in half – June 2012
- 1 month after plasma exchange vitamin D levels reduced by 40 percent – Oct 2013
- With just 200 IU vitamin D in intravenous feeds, deficiency results
- ICU reduces Vitamin D levels, deregulates PTH - Sept 2013
- Critically ill patients with low vitamin D were 13X more likely to have a lot of mitrocondrial DNA in blood – Sept 2014
- ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014
Same hospital? - but with intervention - has the following chart