title: Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill.
abstract: OBJECTIVE
  We hypothesized that deficiency in 25-hydroxyvitamin D prior to hospital admission would be associated with sepsis in the critically ill.
  
  
  METHODS
  Two-center observational study of patients treated in medical and surgical ICUs.
  
  
  METHODS
  Two hundred nine medical and surgical intensive care beds in two teaching hospitals in Boston, MA.
  
  
  METHODS
  Three thousand three hundred eighty-six patients, 18 years old or older, in whom 25-hydroxyvitamin D was measured prior to hospitalization between 1998 and 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  : Preadmission 25-hydroxyvitamin D was categorized as deficiency in 25-hydroxyvitamin D (≤ 15 ng/mL), insufficiency (15-30 ng/mL), and sufficiency (≥ 30 ng/mL). The primary outcome was sepsis as defined by International Classification of Diseases, 9th Edition, Clinical Modification and validated by the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine, American College of Chest Physicians, American Thoracic Society, and Surgical Infection Society international sepsis definitions conference guidelines. Logistic regression examined the presence of sepsis 3 days prior to critical care initiation to 7 days after critical care initiation. Adjusted odds ratios were estimated by multivariable logistic regression models. Preadmission 25-hydroxyvitamin D deficiency is predictive for the risk of sepsis. In the full cohort, 25-hydroxyvitamin D deficiency is a significant predictor for the risk of International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Deyo-Charlson index (adjusted odds ratio, 1.51 [95% CI, 1.17-1.94]; p = 0.001) relative to patients with 25-hydroxyvitamin D sufficiency. In a subset of cohort patients enriched for those with International Classification of Diseases, 9th Edition, Clinical Modification-diagnosed sepsis (n = 444), preadmission 25-hydroxyvitamin D deficiency is a significant predictor for the risk of conference guideline-defined sepsis following multivariable adjustment, including age, gender, race, type (surgical vs medical), and Acute Physiology and Chronic Health Evaluation II (adjusted odds ratio, 2.05 [95% CI, 1.19-3.52]; p = 0.009) relative to patients with 25-hydroxyvitamin D sufficiency. Furthermore, in cohort patients with International Classification of Diseases, 9th Edition, Clinical Modification-defined sepsis (n = 568), the multivariable adjusted risk of 90-day mortality was 1.6-fold higher in those with preadmission 25-hydroxyvitamin D values in the insufficient and deficient range, compared with those with preadmission vitamin D sufficiency (adjusted odds ratio, 1.63 [95% CI, 1.11-2.39]; p = 0.01).
  
  
  CONCLUSIONS
  25-hydroxyvitamin D deficiency prior to hospital admission is a significant predictor of sepsis in the critically ill. Additionally, patients with sepsis who are not vitamin D sufficient have an increased risk of mortality following critical care initiation.
authors: 1The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital, Boston, MA. 2Channing Laboratory and Pulmonary and Critical Care Division, Brigham and Women's Hospital, Boston, MA. 3General Internal Medicine, Massachusetts General Hospital, Boston, MA. 4Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA. 5Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA.
authors: Takuhiro
authors: T
authors: Moromizato
authors: Augusto A
authors: AA
authors: Litonjua
authors: Andrea B
authors: AB
authors: Braun
authors: Fiona K
authors: FK
authors: Gibbons
authors: Edward
authors: E
authors: Giovannucci
authors: Kenneth B
authors: KB
authors: Christopher
mesh_terms: D000368:Aged; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis / Q000097:blood* / Q000209:etiology; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D