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

• DOI: 10.1007/s00774-014-0585-7
• Publication Date: 2014-04-21T14:32:42Z
• Authors: Ravikar Ralph; John Victor Peter; Anugrah Chrispal; Anand Zachariah; Joseph Dian; Tunny Sebastian; Bala Venkatesh; Kurien Thomas
• Keywords: Male; Critical Illness; 610; 25-Hydroxyvitamin D; Middle Aged; Vitamin D Deficiency; Severity of Illness Index; 1310 Endocrinology; 3. Good health; Diabetes and Metabolism; 2712 Endocrinology; Intensive Care Units; 03 medical and health sciences; 2732 Orthopedics and Sports Medicine; 0302 clinical medicine; Humans; Female; Hospital Mortality; Prospective Studies; Mortality; Critical illness; SAPS II score; Cholecalciferol

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.