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Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill.
Crit Care Med. 2014 Jan; 42(1):97-107.CC

Abstract

OBJECTIVE

We hypothesized that deficiency in 25-hydroxyvitamin D prior to hospital admission would be associated with sepsis in the critically ill.

DESIGN

Two-center observational study of patients treated in medical and surgical ICUs.

SETTING

Two hundred nine medical and surgical intensive care beds in two teaching hospitals in Boston, MA.

PATIENTS

Three thousand three hundred eighty-six patients, 18 years old or older, in whom 25-hydroxyvitamin D was measured prior to hospitalization between 1998 and 2011.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

: Preadmission 25-hydroxyvitamin D was categorized as deficiency in 25-hydroxyvitamin D (≤ 15 ng/mL), insufficiency (15-30 ng/mL), and sufficiency (≥ 30 ng/mL). The primary outcome was sepsis as defined by International Classification of Diseases, 9th Edition, Clinical Modification and validated by the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine, American College of Chest Physicians, American Thoracic Society, and Surgical Infection Society international sepsis definitions conference guidelines. Logistic regression examined the presence of sepsis 3 days prior to critical care initiation to 7 days after critical care initiation. Adjusted odds ratios were estimated by multivariable logistic regression models. Preadmission 25-hydroxyvitamin D deficiency is predictive for the risk of sepsis. In the full cohort, 25-hydroxyvitamin D deficiency is a significant predictor for the risk of International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Deyo-Charlson index (adjusted odds ratio, 1.51 [95% CI, 1.17-1.94]; p = 0.001) relative to patients with 25-hydroxyvitamin D sufficiency. In a subset of cohort patients enriched for those with International Classification of Diseases, 9th Edition, Clinical Modification-diagnosed sepsis (n = 444), preadmission 25-hydroxyvitamin D deficiency is a significant predictor for the risk of conference guideline-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Acute Physiology and Chronic Health Evaluation II (adjusted odds ratio, 2.05 [95% CI, 1.19-3.52]; p = 0.009) relative to patients with 25-hydroxyvitamin D sufficiency. Furthermore, in cohort patients with International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis (n = 568), the multivariable adjusted risk of 90-day mortality was 1.6-fold higher in those with preadmission 25-hydroxyvitamin D values in the insufficient and deficient range, compared with those with preadmission vitamin D sufficiency (adjusted odds ratio, 1.63 [95% CI, 1.11-2.39]; p = 0.01).

CONCLUSION

25-hydroxyvitamin D deficiency prior to hospital admission is a significant predictor of sepsis in the critically ill. Additionally, patients with sepsis who are not vitamin D sufficient have an increased risk of mortality following critical care initiation.

Authors+Show Affiliations

1The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Boston, MA. 2Channing Laboratory and Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA. 3General Internal Medicine, Massachusetts General Hospital, Boston, MA. 4Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA. 5Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

23982028

Citation

Moromizato, Takuhiro, et al. "Association of Low Serum 25-hydroxyvitamin D Levels and Sepsis in the Critically Ill." Critical Care Medicine, vol. 42, no. 1, 2014, pp. 97-107.
Moromizato T, Litonjua AA, Braun AB, et al. Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill. Crit Care Med. 2014;42(1):97-107.
Moromizato, T., Litonjua, A. A., Braun, A. B., Gibbons, F. K., Giovannucci, E., & Christopher, K. B. (2014). Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill. Critical Care Medicine, 42(1), 97-107. https://doi.org/10.1097/CCM.0b013e31829eb7af
Moromizato T, et al. Association of Low Serum 25-hydroxyvitamin D Levels and Sepsis in the Critically Ill. Crit Care Med. 2014;42(1):97-107. PubMed PMID: 23982028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill. AU - Moromizato,Takuhiro, AU - Litonjua,Augusto A, AU - Braun,Andrea B, AU - Gibbons,Fiona K, AU - Giovannucci,Edward, AU - Christopher,Kenneth B, PY - 2013/8/29/entrez PY - 2013/8/29/pubmed PY - 2014/2/20/medline SP - 97 EP - 107 JF - Critical care medicine JO - Crit Care Med VL - 42 IS - 1 N2 - OBJECTIVE: We hypothesized that deficiency in 25-hydroxyvitamin D prior to hospital admission would be associated with sepsis in the critically ill. DESIGN: Two-center observational study of patients treated in medical and surgical ICUs. SETTING: Two hundred nine medical and surgical intensive care beds in two teaching hospitals in Boston, MA. PATIENTS: Three thousand three hundred eighty-six patients, 18 years old or older, in whom 25-hydroxyvitamin D was measured prior to hospitalization between 1998 and 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: : Preadmission 25-hydroxyvitamin D was categorized as deficiency in 25-hydroxyvitamin D (≤ 15 ng/mL), insufficiency (15-30 ng/mL), and sufficiency (≥ 30 ng/mL). The primary outcome was sepsis as defined by International Classification of Diseases, 9th Edition, Clinical Modification and validated by the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine, American College of Chest Physicians, American Thoracic Society, and Surgical Infection Society international sepsis definitions conference guidelines. Logistic regression examined the presence of sepsis 3 days prior to critical care initiation to 7 days after critical care initiation. Adjusted odds ratios were estimated by multivariable logistic regression models. Preadmission 25-hydroxyvitamin D deficiency is predictive for the risk of sepsis. In the full cohort, 25-hydroxyvitamin D deficiency is a significant predictor for the risk of International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Deyo-Charlson index (adjusted odds ratio, 1.51 [95% CI, 1.17-1.94]; p = 0.001) relative to patients with 25-hydroxyvitamin D sufficiency. In a subset of cohort patients enriched for those with International Classification of Diseases, 9th Edition, Clinical Modification-diagnosed sepsis (n = 444), preadmission 25-hydroxyvitamin D deficiency is a significant predictor for the risk of conference guideline-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Acute Physiology and Chronic Health Evaluation II (adjusted odds ratio, 2.05 [95% CI, 1.19-3.52]; p = 0.009) relative to patients with 25-hydroxyvitamin D sufficiency. Furthermore, in cohort patients with International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis (n = 568), the multivariable adjusted risk of 90-day mortality was 1.6-fold higher in those with preadmission 25-hydroxyvitamin D values in the insufficient and deficient range, compared with those with preadmission vitamin D sufficiency (adjusted odds ratio, 1.63 [95% CI, 1.11-2.39]; p = 0.01). CONCLUSION: 25-hydroxyvitamin D deficiency prior to hospital admission is a significant predictor of sepsis in the critically ill. Additionally, patients with sepsis who are not vitamin D sufficient have an increased risk of mortality following critical care initiation. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/23982028/Association_of_low_serum_25_hydroxyvitamin_D_levels_and_sepsis_in_the_critically_ill_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31829eb7af DB - PRIME DP - Unbound Medicine ER -