Vitamin D status and the risk for hospital-acquired infections in critically ill adults: a prospective cohort study

Jordan A Kempker, Kathryn G West, Russell R Kempker, Oranan Siwamogsatham, Jessica A Alvarez, Vin Tangpricha, Thomas R Ziegler, Greg S Martin, Jordan A Kempker, Kathryn G West, Russell R Kempker, Oranan Siwamogsatham, Jessica A Alvarez, Vin Tangpricha, Thomas R Ziegler, Greg S Martin

Abstract

Introduction: 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart of Study Enrollment.
Fig 1. Flowchart of Study Enrollment.
Fig 2. Distribution of Serum 25α-hydroxyvitamin D…
Fig 2. Distribution of Serum 25α-hydroxyvitamin D Concentrations.
N = 314.
Fig 3. Adjusted Cox Proportional Hazards Curves…
Fig 3. Adjusted Cox Proportional Hazards Curves for Hospital-Acquired Infections by Vitamin D Status.
N = 314. These curves are adjusted for gender, alcohol use history, APACHE II score, days from ICU admission to study phlebotomy, ICU length of stay and net fluid balance. (APACHE II = acute physiology and chronic health evaluation 2; hospital-acquired infections = Hospital-Acquired Infection; ICU = intensive care unit.)
Fig 4. Cumulative Incidence Function For Hospital-Acquired…
Fig 4. Cumulative Incidence Function For Hospital-Acquired Infection by Vitamin D Status and Accounting For Competing Risk of Hospital Mortality.
(ICU = intensive care unit; LOS = length of stay.)
Fig 5. Kaplan-Meier Survival Curves by Vitamin…
Fig 5. Kaplan-Meier Survival Curves by Vitamin D Status.

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