title: Relationship of vitamin D deficiency to clinical outcomes in critically ill patients.
abstract: BACKGROUND
  Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes.
  
  
  METHODS
  The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes.
  
  
  RESULTS
  Of analyzable patients, 50 (26%) were deficient (≤30 nmol/L) and 109 (56%) were insufficient (>30 and ≤60 nmol/L). Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001). 25(OH)D status was not significantly associated with 28-day all-cause mortality (hazard ratio [HR], 0.89; 95% confidence interval, [CI] 0.37-2.24). Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge (HR, 2.11; 95% CI, 1.27-3.51). 25(OH)D-deficient patients showed a nonstatistically significant trend toward a higher infection rate (odds ratio [OR], 3.20; 95% CI, 0.784-13.07; P = .11) compared with patients with sufficient levels of 25(OH)D.
  
  
  CONCLUSIONS
  This study demonstrates significant decreases in vitamin D status over the duration of the patient's ICU stay. Low levels of vitamin D are associated with longer time to ICU discharge alive and a trend toward increased risk of ICU-acquired infection.
authors.affiliation: Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Higgins
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wischmeyer
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Queensland
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Sillau
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Sufit
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000368:Aged; D002423:Cause of Death; D016001:Confidence Intervals; D016638:Critical Illness / Q000401:mortality; D003428:Cross Infection / Q000097:blood*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000453:epidemiology
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D