Association between prehospital vitamin D status and hospital-acquired bloodstream infections
Am J Clin Nutr October 2013 vol. 98 no. 4 952-959
Sadeq A Quraishi,
Augusto A Litonjua,
Takuhiro Moromizato,
Fiona K Gibbons,
Carlos A Camargo Jr,
Edward Giovannucci, and
Kenneth B Christopher
1 From the Departments of Anesthesia, Critical Care and Pain Medicine (SAQ) and Emergency Medicine (CAC), Massachusetts General Hospital, Boston, MA; the Channing Division of Network Medicine and Pulmonary and Critical Care Division (AAL and FKG) and The Nathan E Hellman Memorial Laboratory, Renal Division (TM and KBC), Department of Medicine, Brigham and Women's Hospital, Boston, MA; and the Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA (EG).
↵2 Supported by the NIH [5T32GM007592-33 and UL1 RR025758 (to SAQ); R01 AI093723 and U01 AI087881 (to CAC); and K08AI060881 (to KBC)].
↵3 Address correspondence to KB Christopher, Renal Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, MRB 418, Boston, MA 02115. E-mail: kbchristopher@partners.org.
Background: Alterations in immune function can predispose patients to nosocomial infections. Few studies have explored potentially modifiable host factors that may improve immune function and decrease risk of hospital-acquired bloodstream infection (HABSI). Vitamin D is a key regulator of innate and adaptive immune systems that may influence host susceptibility to infections.
Objective: We investigated the association between prehospital serum 25-hydroxyvitamin D [25(OH)D] concentrations and risk of HABSI.
Design: We performed a retrospective cohort study of 2135 adult patients from 2 Boston teaching hospitals. All patients had 25(OH)D concentrations measured before hospitalization between 1993 and 2010. The main outcome measure was HABSI, which was defined as positive blood cultures from samples drawn 48 h after hospital admission. Coagulase-negative Staphylococcus isolates were not considered to be bloodstream infections. Associations between 25(OH)D groups and HABSI were estimated by using bivariable and multivariable logistic regression models. Adjusted ORs were estimated with the inclusion of covariate terms thought to plausibly interact with both 25(OH)D concentration and HABSI.
Results: Compared with patients with 25(OH)D concentrations ≥30 ng/mL, patients with concentrations <30 ng/mL had higher odds of HABSI.
- For 25(OH)D concentrations <10 ng/mL, the OR was 2.33 (95% CI: 1.45, 3.74);
- for 25(OH)D concentrations from 10 to 19.9 ng/mL, the OR was 1.60 (95% CI: 1.04, 2.46); and
- for 25(OH)D concentrations from 20 to 29.9 ng/mL, the OR was 1.13 (95% CI: 0.69, 1.84).
After adjustment for age, sex, race (nonwhite compared with white), patient type (medical compared with surgical), and Deyo-Charlson index, the ORs of HABSI were 1.95 (95% CI: 1.22, 3.12), 1.36 (95% CI: 0.89, 2.07), and 0.98 (95% CI: 0.60, 1.62), respectively.
Conclusions: The analysis of 2135 adult patients showed that 25(OH)D concentrations <10 ng/mL before hospitalization were associated with significantly increased odds of developing HABSI. These data support the initiation of randomized trials to test the role of vitamin D supplementation in HABSI prevention.
See also VitaminDWiki
- Vitamin D and Immune Function – Review July 2013
- Vitamin D's potential to reduce the risk of hospital-acquired infections – May 2012
- More sepsis deaths when active vitamin D (Calcitrol) was low – May 2013
- How to reduce hospital infections with vitamin D – April 2012
- MRSA inpatient cost 2X higher if less than 20 ng vitamin D – June 2011
- Chance of dying within 1 month of entering hospital is 45 percent higher if low vitamin D – July 2013