International Journal of Clinical Practice, published online: 6 FEB 2014, DOI: 10.1111/ijcp.12323
A. Marra 1, G. Leoncini 1, M. Mussap 2, M. Bovio 1, E. Nazzari 1, M. Giusti 1, F. Minuto 1, G. Murialdo 1, P. Ameri 1,*
1 Department of Internal Medicine, IRCCS-AOU San Martino-IST, University of Genova, Genova, Italy
2 Department of Laboratory Medicine, IRCCS-AOU San Martino-IST, University of Genova, Genova, Italy
* Correspondence to:Pietro Ameri, MD, Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy; Tel.: +39 010 3538973; Fax: +39 010 3538977
Vitamin D deficiency consequences may go beyond altered calcium homeostasis and musculoskeletal disease. Medical inpatients are often vitamin D-deficient, but little information is available about the relation of vitamin D status with extra-skeletal disorders in this population.
We analysed the relationship between the concentrations of 25-hydroxyvitamin D [25(OH)D], the marker of vitamin D status, and the conditions most commonly causing admission in 115 consecutive medical inpatients.
Sixty-five subjects (56.5%) had severe vitamin D deficiency [25(OH)D < 8 ng/ml].
- Age (β = −0.35, p = 0.01) and
- hepatic disease (β = −0.21, p = 0.02)
were significant correlates of 25(OH)D levels.
Compared with patients with ≥ 8 ng/ml 25(OH)D, those with < 8 ng/ml 25(OH)D had significantly higher parathyroid hormone (PTH) concentrations [123 (92.7–208.2) ng/l vs. 88 (68.5–129.5) ng/l, p < 0.001], were significantly more likely to have
- arterial hypertension (OR 2.76, 95% CI 1.16–6.58),
- heart failure (HF) (OR 2.49, 95% CI 1.14–5.47),
- cerebrovascular disease (OR 3.23, 95% CI 1.41–7.39), and
- infections (OR 2.44, 95% CI 1.02–5.87), and
- stayed in hospital significantly longer (10 days vs. 7.5 days, p = 0.01).
Only the probability of having an infection remained significantly higher in cases with severe vitamin D deficiency after adjustment for age (OR 2.41, 95% CI 1.03–5.68) and persisted after further correcting for presence of hepatic disease and PTH values (OR 2.66, 95% CI 1.03–6.88). A significant association between PTH and HF (OR 2.32, 95% CI 1.05–5.09) and length of hospitalisation (β = 0.22, p = 0.04) emerged in the fully adjusted regression models.
Severe vitamin D deficiency is associated with commonly presenting extra-skeletal diseases in medical inpatients. With the exception of infections, this association is mainly driven by age. Additional studies are needed to determine whether vitamin D testing on admission may help stratifying specific categories of patients by clinical severity.
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The abstract unfortunately does not indicate the age nor reasons that the patients were admitted to the hospital.
Attachment at the bottom of this page indicates that they are probably geriatric patients
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