title: Supraphysiological 25-hydroxy vitamin D3 level at admission is associated with illness severity and mortality in critically ill patients.
abstract: We studied the association between admission serum 25-hydroxy vitamin D3 level and in-hospital mortality in a prospective cohort of critically ill patients admitted to the medical intensive care unit of a tertiary care referral center. Of the 180 patients enrolled, 129 were included. Vitamin D3 deficiency was observed in 37% (n = 48) and supra-physiological levels (≥250 nmol/L) in 15.5% (n = 20). Patients with supraphysiological vitamin D3 levels were grouped as outliers. There was no difference in mortality (p = 0.41) between vitamin D3 deficient (21/48) and non-deficient (36/81) patients in analysis with and without outliers. Patients with vitamin D3 ≥250 nmol/L had a significantly higher (p = 0.02) Simplified Acute Physiology Score (SAPS) II and mortality (p = 0.003) [mean (SD) 60.1 ± 17.1 and 75% (15/20), respectively] when compared with the rest [45.6 ± 18 and 38.5% (42/109), respectively]. The sensitivity, specificity and SAPS II independent odds ratio to predict mortality in patients with supraphysiological vitamin D3 levels were 26.3, 93.1 and 3.7% (95% confidence interval 1.2-11.4; p = 0.03), respectively. In conclusion, vitamin D3 deficiency in our cohort was not associated with mortality. A patient subset with supra-physiological vitamin D levels had higher illness severity scores and mortality. Extrinsic factors interfering with test results were ruled out. A biological hypothesis to explain this observation is proposed. Further clarification of mechanisms leading to this observation is warranted.
authors.affiliation: Department of Medicine, Christian Medical College Hospital (CMCH), Vellore, India, ravikar_ralph@yahoo.com.
authors.forename: Ravikar
authors.initials: R
authors.lastname: Ralph
authors.forename: John Victor
authors.initials: JV
authors.lastname: Peter
authors.forename: Anugrah
authors.initials: A
authors.lastname: Chrispal
authors.forename: Anand
authors.initials: A
authors.lastname: Zachariah
authors.forename: Joseph
authors.initials: J
authors.lastname: Dian
authors.forename: Tunny
authors.initials: T
authors.lastname: Sebastian
authors.forename: Bala
authors.initials: B
authors.lastname: Venkatesh
authors.forename: Kurien
authors.initials: K
authors.lastname: Thomas
mesh_terms: D002762:Cholecalciferol / Q000097:blood*; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D014808:Vitamin D Deficiency / Q000097:blood / Q000401:mortality* / Q000473:pathology*
chemical_list: D002762:Cholecalciferol
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