Abstract
ObjectiveWe hypothesise that low 25-hydroxyvitamin D (25(OH)D) levels before hospitalisation are associated with increased risk of acute respiratory failure.DesignRetrospective cohort study.SettingMedical and Surgical Intensive care units of two Boston teaching hospitals.Patients1985 critically ill adults admitted between 1998 and 2011.InterventionsNone.Measurements and main resultsThe exposure of interest was prehospital serum 25(OH)D categorised as ≤10 ng/mL, 11–19.9 ng/mL, 20–29.9 ng/mL and ≥30 ng/mL. The primary outcome was acute respiratory failure excluding congestive heart failure determined by International Classification of Diseases Ninth Edition (ICD-9) coding and validated against the Berlin Definition of acute respiratory sistress syndrome. Association between 25(OH)D and acute respiratory failure was assessed using logistic regression, while adjusting for age, race, sex, Deyo-Charlson Index and patient type (medical vs surgical).In the cohort, the mean age was 63 years, 45% were male and 80% were white; 25(OH)D was ≤10 ng/mL in 8% of patients, 11–19.9 ng/mL in 24%, 20–29.9 ng/mL in 24% and ≥30 ng/mL in 44% of patients. Eighteen per cent (n=351) were diagnosed with acute respiratory failure. Compared to patients with 25(OH)D ≥30 ng/mL, patients with lower 25(OH)D levels had significantly higher adjusted odds of acute respiratory failure (≤10 ng/mL, OR=1.84 (95% CI 1.22 to 2.77); 11–19.9 ng/mL, OR=1.60 (95% CI 1.19 to 2.15); 20–29.9 ng/mL, OR=1.37 (95% CI 1.01 to 1.86)).ConclusionsPrehospital 25(OH)D was associated with the risk of acute respiratory failure in our critically ill patient cohort.
Highlights
In the USA, every year, 190 600 patients develop acute respiratory distress syndrome KEY MESSAGES▸ Vitamin D deficiency prior to hospitalization is associated with development of acute respiratory failure.▸ Vitamin D deficient patients who develop acute respiratory failure have heightened mortality.(ARDS), with 74 500 associated deaths and 2.2 million days in the intensive care unit (ICU).[1]
Prehospital 25(OH)D was associated with the risk of acute respiratory failure in our critically ill patient cohort
Validation of ICD-9-clinical modification (CM)/current procedural terminology (CPT)-defined acute respiratory failure assignment, as per the Berlin Definition of ARDS, showed that ICD-9-CM/CPT-defined acute respiratory failure assignment had a sensitivity of 59.4%, a specificity of 95.1%, a positive predictive value of 84.4%
Summary
In the USA, every year, 190 600 patients develop acute respiratory distress syndrome KEY MESSAGES▸ Vitamin D deficiency prior to hospitalization is associated with development of acute respiratory failure.▸ Vitamin D deficient patients who develop acute respiratory failure have heightened mortality.(ARDS), with 74 500 associated deaths and 2.2 million days in the intensive care unit (ICU).[1]. In the USA, every year, 190 600 patients develop acute respiratory distress syndrome KEY MESSAGES. ▸ Vitamin D deficient patients who develop acute respiratory failure have heightened mortality. Recent evidence suggests that vitamin D is a key regulator of the innate and adaptive immune system.[5] Serum 25-hydroxyvitamin D (25(OH)D) is the major circulating metabolite of vitamin D, the standard measure of vitamin D status and is used to assess therapeutic response to supplementation. Low serum 25(OH)D levels are associated with increased risk of viral and bacterial infections as well as sepsis possibly due to effects on innate and adaptive immunity.[6 7] vitamin D modulates inflammation, fibrosis and airway destruction in the lung which are major steps in ARDS pathogenesis.[8 9] Further, decreased muscle strength and mass is associated with vitamin D deficiency.[10] Recent data from a randomised controlled
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