Abstract
Clostridium difficile infection (CDI) is a significant source of healthcare-associated morbidity and mortality. This study investigated whether serum 25-hydroxyvitamin D is associated with adverse outcomes from CDI. Patients with CDI were prospectively enrolled. Charts were reviewed and serum 25-hydroxyvitamin D was measured. The primary outcome was a composite definition of severe disease: fever (temperature >38°C), acute organ dysfunction, or serum white blood cell count >15,000 cells/µL within 24-48 hours of diagnosis; lack of response to therapy by day 5; and intensive care unit admission; colectomy; or death within 30 days. Sixty-seven patients were included in the final analysis. Mean (±SD) serum 25-hydroxyvitamin D was 26.1 (±18.54) ng/mL. Severe disease, which occurred in 26 (39%) participants, was not associated with serum 25-hydroxyvitamin D [odds ratio (OR) 1.00; 95% confidence interval (CI) 0.96-1.04]. In the adjusted model for severe disease only serum albumin (OR 0.12; 95%CI 0.02-0.64) and diagnosis by detection of stool toxin (OR 5.87; 95%CI 1.09-31.7) remained independent predictors. We conclude that serum 25-hydroxyvitamin D is not associated with the development of severe disease in patients with CDI.
Highlights
Ethics statementThis study was approved by the University of Michigan Institutional Review Board
Serum 25-hydroxyvitamin D level, variables found to be significant on univariate analysis, and those with a priori clinical significance were included in the final multivariable model
Variations in the serum 25-hydroxyvitamin D including log transformation and characterization as a categorical variable were performed in the final model without difference in the strength of association; modeling as a continuous variable was presented in the final model
Summary
The University of Michigan Health System includes a 930-bed tertiary care inpatient facility. The following variables were extracted by chart review: exogenous vitamin D supplementation (cholecalciferol) or 1,25-dihydroxycholecalciferol (calcitriol) use at the time of admission; residence in an extended care facility (ECF) prior to admission; and the surveillance definitions for the likely site of C. difficile acquisition, as recommended by McDonald et al.[14] (community-associated CA) CDI [symptoms began in the community or within 48 hours of admission to the hospital provided that the onset of symptoms was dysfunction (AOD) (acute kidney injury per RIFLE criteria,[17] acute respiratory distress syndrome (if listed in the chart or meeting criteria of a PaO2/FiO2
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