title: Addition of vitamin D status to prognostic scores improves the prediction of outcome in community-acquired pneumonia.
abstract: BACKGROUND
  Vitamin D plays a role in host defense against infection. Vitamin D deficiency is common worldwide. The prognostic value of vitamin D levels in pneumonia is unknown. In this study, we aimed to investigate the impact of vitamin D status on outcome in community-acquired pneumonia (CAP).
  
  
  METHODS
  We conducted a prospective cohort study in 272 hospitalized patients with CAP. Levels of 25-hydroxyvitamin D, leukocytes, C-reactive protein, and total cortisol and the Pneumonia Severity Index (PSI) and CURB-65 scores were measured on admission. Major outcome measures were intensive care unit (ICU) admission and 30-day mortality.
  
  
  RESULTS
  One hundred forty-three patients (53%) were vitamin D deficient (<50 nmol/L), 79 patients (29%) were vitamin D insufficient (50-75 nmol/L), and 50 patients (18%) were vitamin D sufficient (>75 nmol/L). Vitamin D deficiency was associated with an increased risk of ICU admission and 30-day mortality. Vitamin D status was an independent predictor of 30-day mortality (area under the curve [AUC] =0.69; 95% confidence interval [CI], .57-.80). Multivariate regression analysis including all predictors for outcome resulted in a final model including vitamin D status and the PSI score, with a significantly higher prognostic accuracy compared with the PSI score alone (AUC=0.83; 95% CI, .71-.94).
  
  
  CONCLUSIONS
  Vitamin D deficiency is associated with adverse outcome in CAP. Vitamin D status is an independent predictor of 30-day mortality and adds prognostic value to other biomarkers and prognostic scores, in particular the PSI score.
  
  
  BACKGROUND
  NCT00471640.
authors.affiliation: Department of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands. h.remmelts@antoniusziekenhuis.nl
authors.forename: Hilde H F
authors.initials: HH
authors.lastname: Remmelts
authors.forename: Ewoudt M W
authors.initials: EM
authors.lastname: van de Garde
authors.forename: Sabine C A
authors.initials: SC
authors.lastname: Meijvis
authors.forename: Evelyn L G C A
authors.initials: EL
authors.lastname: Peelen
authors.forename: Jan G M C
authors.initials: JG
authors.lastname: Damoiseaux
authors.forename: Jan C
authors.initials: JC
authors.lastname: Grutters
authors.forename: Douwe H
authors.initials: DH
authors.lastname: Biesma
authors.forename: Willem Jan W
authors.initials: WJ
authors.lastname: Bos
authors.forename: Ger T
authors.initials: GT
authors.lastname: Rijkers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018410:Pneumonia, Bacterial / Q000097:blood / Q000473:pathology*; D012621:Seasons; D016896:Treatment Outcome; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000473:pathology*
chemical_list: D015415:Biomarkers; D014807:Vitamin D