title: Addition of 25-hydroxyvitamin D levels to the Deyo-Charlson Comorbidity Index improves 90-day mortality prediction in critically ill patients.
abstract: BACKGROUND
  The Deyo-Charlson Comorbidity Index (DCCI) has low predictive value in the intensive care unit (ICU). Our goal was to determine whether addition of 25-hydroxyvitamin D (25OHD) levels to the DCCI improved 90-day mortality prediction in critically ill patients.
  
  
  METHODS
  Plasma 25OHD levels, DCCI, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were assessed within 24 h of admission in 310 ICU patients. Receiver operating characteristic curves of the prediction scores, without and with the addition of 25OHD levels, for 90-day mortality were constructed and the areas under the curve (AUC) were compared for equality.
  
  
  RESULTS
  Mean (standard deviation) plasma 25OHD levels, DCCI, and APACHE II score were 19 (SD 8) ng/mL, 4 (SD 3), and 17 (SD 9), respectively. Overall 90-day mortality was 19 %. AUC for DCCI vs. DCCI + 25OHD was 0.68 (95 % CI 0.58-0.77) vs. 0.75 (95 % CI 0.67-0.83); p < 0.001. AUC for APACHE II vs. APACHE II + 25OHD was 0.81 (95 % CI 0.73-0.88) vs. 0.82 (95 % CI 0.75-0.89); p < 0.001. There was a significant difference between the AUC for DCCI + 25OHD and APACHE II + 25OHD (p = 0.04) but not between the AUC for DCCI + 25OHD and APACHE II (p = 0.12).
  
  
  CONCLUSIONS
  In our cohort of ICU patients, the addition of 25OHD levels to the DCCI improved 90-day mortality prediction compared to the DCCI alone. Moreover, the predictive capability of DCCI + 25OHD was comparable to that of APACHE II. Future prospective studies are needed to validate our findings and to determine whether the use of DCCI + 25OHD can influence clinical decision-making.
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 402, Boston, MA USA ; Harvard Medical School, Boston, MA USA ; Department of Anesthesiology & Perioperative Care, University of California - Irvine, Orange, CA USA.
authors.forename: Bisundev
authors.initials: B
authors.lastname: Mahato
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 402, Boston, MA USA ; Tufts University School of Medicine, Boston, MA USA.
authors.forename: Tiffany M N
authors.initials: TM
authors.lastname: Otero
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA USA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Holland
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 402, Boston, MA USA.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Giguere
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA USA ; Department of Medicine, Harvard Medical School, Boston, MA USA.
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA USA ; Department of Medicine, Harvard Medical School, Boston, MA USA ; Department of Epidemiology, Harvard School of Public Health, Boston, MA USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, GRJ 402, Boston, MA USA ; Department of Anaesthesia, Harvard Medical School, Boston, MA USA.
authors.forename: Sadeq A
authors.initials: SA
authors.lastname: Quraishi
keywords: 25-hydroxyvitamin D; ICU; Mortality; Vitamin D