title: Vitamin D status and severity of Clostridium difficile infections: a prospective cohort study in hospitalized adults.
abstract: BACKGROUND
  Clostridium difficile is the most common cause of nosocomial diarrhea, affecting up to 10% of hospitalized patients. Preliminary studies suggest an association between vitamin D status and C difficile infections (CDIs). Our goal was to investigate whether serum 25-hydroxyvitamin D (25(OH)D) levels are associated with CDI severity.
  
  
  METHODS
  We prospectively enrolled patients diagnosed with CDI and divided them into 2 severity groups: group A (positive toxin A/B enzyme immunoassay only) and group B (positive toxin A/B enzyme immunoassay with abdominal computed tomography scan findings consistent with colitis). Serum 25(OH)D levels (25(OH)D3, 25(OH)D2, and total 25(OH)D) were measured on all patients after diagnosis of CDI. We performed multivariable logistic regression analyses to investigate the association between 25(OH)D levels and CDI severity, while adjusting for age, Deyo-Charlson Comorbidity Index, recent hospitalization, and vitamin D supplementation.
  
  
  RESULTS
  One hundred patients were enrolled between July 2011 and February 2013. The mean (standard deviation) cohort age and Deyo-Charlson Comorbidity Index were 62 (19) years and 4 (3), respectively; 54% of patients were male. Mean serum total 25(OH)D level was 22 (10) ng/mL. Mean 25(OH)D3 level was significantly higher in group A (n = 71) than in group B (n = 29): 21 (1) vs 15 (2) ng/mL, respectively (P = .005). There was no observed difference in mean 25(OH)D2 levels and total 25(OH)D levels between the 2 groups. Multivariable logistic regression analysis demonstrated an association between 25(OH)D3 levels and CDI severity (adjusted odds ratio, 0.92; 95% confidence interval, 0.87-0.98).
  
  
  CONCLUSIONS
  We found a significant inverse association between 25(OH)D3 levels and CDI severity. Further studies are needed to determine whether vitamin D supplementation can improve outcomes in patients with CDI.
authors.affiliation: Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston Department of Surgery and Trauma Surgery, Leiden University Medical Center and Leiden University, Leiden, the Netherlands G.M.van_der_Wilden@lumc.nl.
authors.forename: Gwendolyn M
authors.initials: GM
authors.lastname: van der Wilden
authors.affiliation: Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Fagenholz
authors.affiliation: Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston.
authors.forename: Sadeq A
authors.initials: SA
authors.lastname: Quraishi
authors.affiliation: Department of Surgery and Trauma Surgery, Leiden University Medical Center and Leiden University, Leiden, the Netherlands.
authors.forename: Inger B
authors.initials: IB
authors.lastname: Schipper
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002112:Calcifediol / Q000097:blood*; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000097:blood / Q000150:complications* / Q000382:microbiology; D003092:Colitis / Q000209:etiology / Q000382:microbiology; D003428:Cross Infection / Q000097:blood / Q000150:complications / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012720:Severity of Illness Index; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D; D002112:Calcifediol
keywords: 25(OH)D; Clostridium difficile; vitamin D