title: Pre-hospital vitamin D concentration, mortality, and bloodstream infection in a hospitalized patient population.
abstract: OBJECTIVE
  The study objective was to examine the association between pre-hospital serum vitamin D concentration and mortality after hospitalization.
  
  
  METHODS
  We performed a retrospective cohort study in 2 tertiary hospitals in Boston, Mass, on 23,603 patients aged ≥18 years in whom 25(OH)D was measured before hospitalization between 1993 and 2010. The main outcome measures were all-cause mortality by day 30 post-hospital admission, in-hospital mortality, and community-acquired bloodstream infection.
  
  
  RESULTS
  Compared with patients with pre-hospital 25(OH)D ≥30 ng/mL, patients with pre-hospital 25(OH)D ≤15 ng/mL or 15 to 30 ng/mL have higher odds of mortality 30 days after hospital admission. After adjustment for age, gender, race, Deyo-Charlson index, season, type (surgical vs medical), creatinine, blood urea nitrogen, hematocrit, and time between 25(OH)D draw and hospital admission, the adjusted odds ratio (OR) of 30-day mortality in patients with 25(OH)D ≤15 ng/mL is 1.45 (95% confidence interval [CI], 1.21-1.74; P<.0001) and the adjusted OR of 30-day mortality in patients with 25(OH)D 15 to 30 ng/mL is 1.30 (95% CI, 1.10-1.54; P = .003) both compared with patients with pre-hospital 25(OH)D ≥30 ng/mL. In a subgroup analysis of patients who had blood cultures drawn (n = 5628), pre-hospital serum 25(OH)D ≤15 ng/mL was associated with increased odds of community-acquired bloodstream infection (adjusted OR, 1.29; 95% CI, 1.06-1.57; P = .01) relative to patients with 25(OH)D ≥30 ng/mL.
  
  
  CONCLUSIONS
  Analysis of 23,603 hospitalized patients identified both 25(OH)D ≤15 ng/mL and 25(OH)D 15 to 30 ng/mL before hospital admission as associated with the odds of all-cause patient mortality at 30 days after hospitalization. In addition, pre-hospital serum 25(OH)D ≤15 ng/mL is significantly associated with the odds of community-acquired bloodstream infection.
authors.affiliation: Pulmonary Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Lange
authors.forename: Augusto A
authors.initials: AA
authors.lastname: Litonjua
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Gibbons
authors.forename: Edward
authors.initials: E
authors.lastname: Giovannucci
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Christopher
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001900:Boston; D017714:Community-Acquired Infections / Q000209:etiology / Q000401:mortality*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000401:mortality*; D062606:Tertiary Care Centers; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000150:complications*
chemical_list: D014807:Vitamin D