Increased mortality if more than 100 ng of vitamin D – not much detail – April 2014

Supraphysiological 25-hydroxy vitamin D3 level at admission is associated with illness severity and mortality in critically ill patients

Ravikar Ralph, John Victor Peter, Anugrah Chrispal, Anand Zachariah, Joseph Dian, Tunny Sebastian, Bala Venkatesh, Kurien Thomas
Journal of Bone and Mineral Metabolism, April 2014

We studied the association between admission serum 25-hydroxy vitamin D3 level and in-hospital mortality in a prospective cohort of critically ill patients admitted to the medical intensive care unit of a tertiary care referral center. Of the 180 patients enrolled, 129 were included. Vitamin D3 deficiency was observed in 37 % (n = 48) and supra-physiological levels (≥250 nmol/L) in 15.5 % (n = 20). Patients with supraphysiological vitamin D3 levels were grouped as outliers. There was no difference in mortality (p = 0.41) between vitamin D3 deficient (21/48) and non-deficient (36/81) patients in analysis with and without outliers.

Patients with vitamin D3 ≥250 nmol/L had a significantly higher (p = 0.02) Simplified Acute Physiology Score (SAPS) II and mortality (p = 0.003) [mean (SD) 60.1 ± 17.1 and 75 % (15/20), respectively] when compared with the rest [45.6 ± 18 and 38.5 % (42/109), respectively]. The sensitivity, specificity and SAPS II independent odds ratio to predict mortality in patients with supraphysiological vitamin D3 levels were 26.3, 93.1 and 3.7 % (95 % confidence interval 1.2–11.4; p = 0.03), respectively.

In conclusion, vitamin D3 deficiency in our cohort was not associated with mortality.
A patient subset with supra-physiological vitamin D levels had higher illness severity scores and mortality.
Extrinsic factors interfering with test results were ruled out.
A biological hypothesis to explain this observation is proposed.
Further clarification of mechanisms leading to this observation is warranted.

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Many questions from the abstract

1. How long between vitamin D measurement and death?
2. Had the patients been taking lots of vitamin D?
3. Were their bodies getting too much for some other reason?
4. Was this group out in the sun A LOT?
5. What is the biological hypothesis proposed in the $40 study?
6. Which cofactors were inbalanced: Calcium, Magnesium, Vitamin K2, or what?
   Vitamin D is a poor monotherapy for levels > 50 ng or so.
7. Virtually all other studies of critcal care patients have found very low levels - why were17% of their patients so high?

See also VitaminDWiki

• Even if a J curve exists, it is 50X better to give vitamin D than not give it – May 2013
• Mortality increased with highest levels of vitamin D – article and 4 letters Aug 2012
• All-cause mortality does not relate to vitamin D tests years earlier - April 2012
• All items in category Mortality and Vitamin D 321 items
• Is 50 ng of vitamin D too high, just right, or not enough
• Low Magnesium in 40 percent of critical care patients – increased hospital days and death - Jan 2014
• Trauma and surgery category listing with associated searches
• Search VitaminDWiki for ICU OR “critical care” OR “intensive care” OR “acute care” 569 items as of April 2014