title: Admission vitamin D status is associated with discharge destination in critically ill surgical patients.
abstract: BACKGROUND
  Discharge destination after critical illness is increasingly recognized as a valuable patient-centered outcome. Recently, vitamin D status has been shown to be associated with important outcomes such as length of stay (LOS) and mortality in intensive care unit (ICU) patients. Our goal was to investigate whether vitamin D status on ICU admission is associated with discharge destination.
  
  
  METHODS
  We performed a retrospective analysis from an ongoing prospective cohort study of vitamin D status in critical illness. Patients were recruited from two surgical ICUs at a single teaching hospital in Boston, Massachusetts. All patients had 25-hydroxyvitamin D (25OHD) levels measured within 24 h of ICU admission. Discharge destination was dichotomized as non-home or home. Locally weighted scatterplot smoothing (LOWESS) was used to graph the relationship between 25OHD levels and discharge destination. To investigate the association between 25OHD level and discharge destination, we performed logistic regression analyses, controlling for age, sex, race, body mass index, socioeconomic status, acute physiology and chronic health evaluation II score, need for emergent vs. non-emergent surgery, vitamin D supplementation status, and hospital LOS.
  
  
  RESULTS
  300 patients comprised the analytic cohort. Mean 25OHD level was 19 (standard deviation 8) ng/mL and 41 % of patients had a non-home discharge destination. LOWESS analysis demonstrated a near-inverse linear relationship between vitamin D status and non-home discharge destination to 25OHD levels around 10 ng/mL, with rapid flattening of the curve between levels of 10 and 20 ng/mL. Overall, 25OHD level at the outset of critical illness was inversely associated with non-home discharge destination (adjusted OR, 0.88; 95 % CI 0.82-0.95). When vitamin D status was dichotomized, patients with 25OHD levels <20 ng/mL had an almost 3-fold risk of a non-home discharge destination (adjusted OR, 2.74; 95 % CI 1.23-6.14) compared to patients with 25OHD levels ≥20 ng/mL.
  
  
  CONCLUSIONS
  Our results suggest that vitamin D status may be a modifiable risk factor for non-home discharge destination in surgical ICU patients. Future randomized, controlled trials are needed to determine whether vitamin D supplementation in surgical ICU patients can improve clinical outcomes such as the successful rate of discharge to home after critical illness.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 402, Boston, MA, 02114, USA. kbrook@mgh.harvard.edu.
authors.forename: Karolina
authors.initials: K
authors.lastname: Brook
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. ccamargo@partners.org.|Department of Medicine, Harvard Medical School, Boston, MA, USA. ccamargo@partners.org.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. ccamargo@partners.org.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Medicine, Harvard Medical School, Boston, MA, USA. kchristopher@bwh.harvard.edu.|Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. kchristopher@bwh.harvard.edu.
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Christopher
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 402, Boston, MA, 02114, USA. squraishi@mgh.harvard.edu.|Department of Anaesthesia, Harvard Medical School, Boston, MA, USA. squraishi@mgh.harvard.edu.
authors.forename: Sadeq A
authors.initials: SA
authors.lastname: Quraishi
keywords: 25-hydroxyvitamin D; Critical illness; Discharge destination; Patient-centered outcome; Vitamin D