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Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality*

Braun, Andrea B. MD; Gibbons, Fiona K. MD; Litonjua, Augusto A. MD, MPH; Giovannucci, Edward MD, ScD; Christopher, Kenneth B. MD

doi: 10.1097/CCM.0b013e31822d74f3
Clinical Investigations

Objective: We hypothesized that deficiency in 25-hydroxyvitamin D at critical care initiation would be associated with all-cause mortalities.

Design: Two-center observational study.

Setting: Two teaching hospitals in Boston, MA.

Patients: The study included 1,325 patients, age ≥18 yrs, in whom 25-hydroxyvitamin D was measured 7 days before or after critical care initiation between 1998 and 2009.

Measurements: 25-hydroxyvitamin D was categorized as deficiency in 25-hydroxyvitamin D (≤15 ng/mL), insufficiency (16–29 ng/mL), and sufficiency (≥30 ng/mL). Logistic regression examined death by days 30, 90, and 365 postcritical care initiation and in-hospital mortality. Adjusted odds ratios were estimated by multivariable logistic regression models.

Interventions: None.

Key Results: 25-hydroxyvitamin D deficiency is predictive for short-term and long-term mortality. Thirty days following critical care initiation, patients with 25-hydroxyvitamin D deficiency have an odds ratio for mortality of 1.85 (95% confidence interval 1.15–2.98; p = .01) relative to patients with 25-hydroxyvitamin D sufficiency. 25-hydroxyvitamin D deficiency remains a significant predictor of mortality at 30 days following critical care initiation following multivariable adjustment for age, gender, race, Deyo-Charlson index, sepsis, season, and surgical vs. medical patient type (adjusted odds ratio 1.94; 95% confidence interval 1.18–3.20; p = .01). Results were similarly significant at 90 and 365 days following critical care initiation and for in-hospital mortality. The association between vitamin D and mortality was not modified by sepsis, race, or neighborhood poverty rate, a proxy for socioeconomic status.

Conclusion: Deficiency of 25-hydroxyvitamin D at the time of critical care initiation is a significant predictor of all-cause patient mortality in a critically ill patient population.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site ( SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the Renal Division (ABB, KBC), Pulmonary and Critical Care Division (AAL), and The Nathan E. Hellman Memorial Laboratory (KBC), Brigham and Women's Hospital; Pulmonary Division (FKG), Massachusetts General Hospital; and the Departments of Nutrition and Epidemiology (EG), Harvard School of Public Health, Boston, MA.

* See also p. 310.

Supported, in part, by NIH K08AI060881 (KBC).

The authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins