Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2 D are associated with disease severity.
OBJECTIVE
We aimed to explore the association between vitamin D levels and the severity, mortality and microbiological etiology of community-acquired pneumonia.


METHODS
Vitamin D levels (both, the reservoir form 25-OH and the activated form 1,25-OH2) of 300 randomly selected patients with community-acquired pneumonia due to pre-specified pathogens included in the German competence network (CAPNETZ) study were measured. Prior to statistical analysis, values of 25-OH and 1,25-OH2 were power-transformed to achieve parametric distribution. All further analyses were performed with seasonally and age adjusted values.


RESULTS
There was only a modest (Spearman Coefficient 0.38) positive correlation between 25-OH and 1,25-OH2. For 1,25-OH2 but not 25-OH, the general linear model revealed a significant inverse correlation between serum concentration and CURB score (p = 0.011). Liver and respiratory co-morbidity were associated with significantly lower 25-OH values and renal co-morbidity with significantly lower 1,25-OH2 values. No significant differences of 1,25-OH2 or 25-OH between different pathogens (influenza virus, Legionella spp., Streptococcus pneumoniae) were detected.


CONCLUSIONS
For 1,25-OH2, we found a significant and independent (controlled for age, season and pathogen) negative correlation to pneumonia severity. Therefore, supplementation of non-activated vitamin D to protect from pneumonia may be non-sufficient in patients that have a decreased capacity to hydroxylate 25-OH to 1,25-OH2.
Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740 Jena, Germany. mathias.pletz@med.uni-jena.de.
Mathias W
MW
Pletz
Christoph
C
Terkamp
Ulrike
U
Schumacher
Gernot
G
Rohde
Hartwig
H
Schütte
Tobias
T
Welte
Robert
R
Bals
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004097:Dihydrotachysterol / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D012621:Seasons; D012720:Severity of Illness Index; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology
C118268:1,25-dihydroxydihydrotachysterol(2); D015415:Biomarkers; D014807:Vitamin D; D004097:Dihydrotachysterol