title: Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality.
abstract: OBJECTIVE
  We hypothesized that deficiency in 25-hydroxyvitamin D at critical care initiation would be associated with all-cause mortalities.
  
  
  METHODS
  Two-center observational study.
  
  
  METHODS
  Two teaching hospitals in Boston, MA.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  None.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Renal Division, Brigham and Women's Hospital, Boston, MA, USA. kbchristopher@partners.org
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Braun
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Gibbons
authors.forename: Augusto A
authors.initials: AA
authors.lastname: Litonjua
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Christopher
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000401:mortality*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D