Supraphysiological 25-hydroxy vitamin D3 level at admission is associated with illness severity and mortality in critically ill patients

Ralph, Ravikar, Peter, John Victor, Chrispal, Anugrah, Zachariah, Anand, Dian, Joseph, Sebastian, Tunny, Venkatesh, Bala and Thomas, Kurien (2014) Supraphysiological 25-hydroxy vitamin D3 level at admission is associated with illness severity and mortality in critically ill patients. Journal of Bone and Mineral Metabolisma, 33 2: 239-243. doi:10.1007/s00774-014-0585-7


Author Ralph, Ravikar
Peter, John Victor
Chrispal, Anugrah
Zachariah, Anand
Dian, Joseph
Sebastian, Tunny
Venkatesh, Bala
Thomas, Kurien
Title Supraphysiological 25-hydroxy vitamin D3 level at admission is associated with illness severity and mortality in critically ill patients
Journal name Journal of Bone and Mineral Metabolisma   Check publisher's open access policy
ISSN 0914-8779
1435-5604
Publication date 2014-04-22
Year available 2014
Sub-type Article (original research)
DOI 10.1007/s00774-014-0585-7
Open Access Status
Volume 33
Issue 2
Start page 239
End page 243
Total pages 5
Place of publication Tokyo, Japan
Publisher Springer Japan
Collection year 2015
Language eng
Abstract We studied the association between admission serum 25-hydroxy vitamin D3 level and in-hospital mortality in a prospective cohort of critically ill patients admitted to the medical intensive care unit of a tertiary care referral center. Of the 180 patients enrolled, 129 were included. Vitamin D3 deficiency was observed in 37 % (n = 48) and supra-physiological levels (≥250 nmol/L) in 15.5 % (n = 20). Patients with supraphysiological vitamin D3 levels were grouped as outliers. There was no difference in mortality (p = 0.41) between vitamin D3 deficient (21/48) and non-deficient (36/81) patients in analysis with and without outliers. Patients with vitamin D3≥250 nmol/L had a significantly higher (p = 0.02) Simplified Acute Physiology Score (SAPS) II and mortality (p = 0.003) [mean (SD) 60.1 ± 17.1 and 75 % (15/20), respectively] when compared with the rest [45.6 ± 18 and 38.5 % (42/109), respectively]. The sensitivity, specificity and SAPS II independent odds ratio to predict mortality in patients with supraphysiological vitamin D3 levels were 26.3, 93.1 and 3.7 % (95 % confidence interval 1.2-11.4; p = 0.03), respectively. In conclusion, vitamin D3 deficiency in our cohort was not associated with mortality. A patient subset with supra-physiological vitamin D levels had higher illness severity scores and mortality. Extrinsic factors interfering with test results were ruled out. A biological hypothesis to explain this observation is proposed. Further clarification of mechanisms leading to this observation is warranted.
Keyword 25-Hydroxyvitamin D
Critical illness
SAPS II score
Mortality
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
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