Addition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired Pneumonia

• Published in: Clinical infectious diseases 2012-12, Vol.55 (11), p.1488-1494
• Main Authors: Remmelts, Hilde H. F., van de Garde, Ewoudt M. W., Meijvis, Sabine C. A., Peelen, Evelyn L. G. C. A., Damoiseaux, Jan G. M. C., Grutters, Jan C., Biesma, Douwe H., Bos, Willem Jan W., Rijkers, Ger T.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biological markers; Biomarkers; Cohort Studies; Community-Acquired Infections - pathology; Female; Health outcomes; Hospital admissions; Humans; Infections; Infectious diseases; Intensive care units; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Odds Ratio; Older adults; Pneumology; Pneumonia; Pneumonia, Bacterial - blood; Pneumonia, Bacterial - pathology; Regression analysis; Respiratory system : syndromes and miscellaneous diseases; Seasons; Treatment Outcome; Vitamin D; Vitamin D - blood; Vitamin D deficiency; Vitamin D Deficiency - pathology; Vitamin deficiency
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cis751

Background. Vitamin D plays a role in host defense against infection. Vitamin D deficiency is common worldwide. The prognostic value of vitamin D levels in pneumonia is unknown. In this study, we aimed to investigate the impact of vitamin D status on outcome in community-acquired pneumonia (CAP). Methods. We conducted a prospective cohort study in 272 hospitalized patients with CAP. Levels of 25-hydroxyvitamin D, leukocytes, C-reactive protein, and total cortisol and the Pneumonia Severity Index (PSI) and CURB-65 scores were measured on admission. Major outcome measures were intensive care unit (ICU) admission and 30-day mortality. Results. One hundred forty-three patients (53%) were vitamin D deficient (< 50 nmol/L), 79 patients (29%) were vitamin D insufficient (50-75 nmol/L), and 50 patients (18%) were vitamin D sufficient (> 75 nmol/L). Vitamin D deficiency was associated with an increased risk of ICU admission and 30-day mortality. Vitamin D status was an independent predictor of 30-day mortality (area under the curve [AUC] = 0.69; 95% confidence interval [CI], .57-.80). Multivariate regression analysis including all predictors for outcome resulted in a final model including vitamin D status and the PSI score, with a significantly higher prognostic accuracy compared with the PSI score alone (AUC = 0.83; 95% CI, .71-.94). Conclusions. Vitamin D deficiency is associated with adverse outcome in CAP. Vitamin D status is an independent predictor of 30-day mortality and adds prognostic value to other biomarkers and prognostic scores, in particular the PSI score. Clinical Trials Registration. NCT00471640.