title: Vitamin D status and the risk for hospital-acquired infections in critically ill adults: a prospective cohort study.
abstract: BACKGROUND
  To identify patient characteristics associated with low serum 25-hydroxyvitamin D (25(OH)D) concentrations in the medical intensive care unit (ICU) and examine the relationship between serum 25(OH)D and the risk for hospital-acquired infections.
  
  
  METHODS
  This is a prospective observational cohort of adult patients admitted to the medical ICU at an urban safety net teaching hospital in Atlanta, Georgia from November 1, 2011 through October 31, 2012 with an anticipated ICU stay ≥ 1 day. Phlebotomy for serum 25(OH)D measurement was performed on all patients within 5 days of ICU admission. Patients were followed for 30 days or until death or hospital discharge, whichever came first. Hospital-acquired infections were determined using standardized criteria from review of electronic medical record.
  
  
  RESULTS
  Among the 314 patients analyzed, 178 (57%) had a low vitamin D at a serum 25(OH)D concentration < 15 ng/mL. The patient characteristics associated with low vitamin D included admission during winter months (28% vs. 18%, P = 0.04), higher PaO2/FiO2 (275 vs. 226 torr, P = 0.03) and a longer time from ICU admission to study phlebotomy (1.8 vs. 1.5 days, P = 0.02). A total of 36 (11%) patients were adjudicated as having a hospital-acquired infection and in multivariable analysis adjusting for gender, alcohol use, APACHE II score, time to study phlebotomy, ICU length of stay and net fluid balance, serum 25(OH)D levels < 15 ng/mL were not associated with risk for hospital-acquired infections (HR 0.85, 95% CI 0.40-1.80, P = 0.7).
  
  
  CONCLUSIONS
  In this prospective, observational cohort of adults admitted to a single-center medical ICU, we did not find a significant association between low 25(OH)D and the risk for hospital-acquired infections.
authors: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205, Atlanta, GA 30322, United States of America.
authors: Jordan A
authors: JA
authors: Kempker
authors: Emory University School of Medicine, Atlanta, United States of America.
authors: Kathryn G
authors: KG
authors: West
authors: Division of Infectious Diseases, Emory University School of Medicine, Atlanta, United States of America.
authors: Russell R
authors: RR
authors: Kempker
authors: Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, United States of America.
authors: Oranan
authors: O
authors: Siwamogsatham
authors: Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, United States of America.
authors: Jessica A
authors: JA
authors: Alvarez
authors: Division of Endocrinology, Metabolism and Lipids, Atlanta VA Medical Center & Emory University School of Medicine, Atlanta, United States of America.
authors: Vin
authors: V
authors: Tangpricha
authors: Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, United States of America.
authors: Thomas R
authors: TR
authors: Ziegler
authors: Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205, Atlanta, GA 30322, United States of America.
authors: Greg S
authors: GS
authors: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness; D003428:Cross Infection / Q000097:blood* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D055815:Young Adult
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D