Vitamin D and whether you’ll leave the hospital dead or alive

Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill.

We hypothesized that deficiency in 25-hydroxyvitamin D before hospital admission would be associated with all-cause mortality in the critically ill….

MEASUREMENTS AND MAIN RESULTS:
Preadmission 25-hydroxyvitamin D deficiency is predictive for short-term and long-term mortality. At 30 days following intensive care unit admission, patients with 25-hydroxyvitamin D deficiency have an odds ratio for mortality of 1.69 (95% confidence interval of 1.28-2.23, p < .0001) relative to patients with 25-hydroxyvitamin D sufficiency. 25-Hydroxyvitamin D deficiency remains a significant predictor of mortality at 30 days following intensive care unit admission following multivariable adjustment (adjusted odds ratio of 1.69, 95% confidence interval of 1.26-2.26, p < .0001). At 30 days following intensive care unit admission, patients with 25-hydroxyvitamin D insufficiency have an odds ratio of 1.32 (95% confidence interval of 1.02-1.72, p = .036) and an adjusted odds ratio of 1.36 (95% confidence interval of 1.03-1.79, p = .029) relative to patients with 25-hydroxyvitamin D sufficiency. Results were similar at 90 and 365 days following intensive care unit admission and for in-hospital mortality. In a subgroup analysis of patients who had blood cultures drawn (n = 1160), 25-hydroxyvitamin D deficiency was associated with increased risk of blood culture positivity. Patients with 25-hydroxyvitamin D insufficiency have an odds ratio for blood culture positivity of 1.64 (95% confidence interval of 1.05-2.55, p = .03) relative to patients with 25-hydroxyvitamin D sufficiency, which remains significant following multivariable adjustment (odds ratio of 1.58, 95% confidence interval of 1.01-2.49, p = .048). CONCLUSION: Deficiency of 25-hydroxyvitamin D before hospital admission is a significant predictor of short- and long-term all-cause patient mortality and blood culture positivity in a critically ill patient population.

No one knows when they’re going to end up critically ill and/or in the hospital. But if you want to live through the experience and come out the other end alive, make sure you’re vitamin D sufficient.

The blood culture positivity is interesting. As is well known, hospital-acquired infections are a major problem, including blood-borne infections; the latter are extremely serious and have a high fatality rate. I can think of no other reason for vitamin D levels to be associated with blood infections other than causality: vitamin D deficiency causes a defect in immunity.

I’m not sure why, given results like these, that hospitals wouldn’t ensure that all of their critically ill patients are vitamin D sufficient.

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