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

• Type of Material: Article
• Authors: Jordan Kempker, Emory University; Kathryn G. West, Emory University; Russell Ryan Kempker, Emory University; Oranan Siwamogsatham, Emory University; Jessica A. Alvarez, Emory University; Vin Tangpricha, Emory University; Thomas Ziegler, Emory University; Greg Martin, Emory University
• Language: English
• Date: 2015-04-07
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Kempker et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0122136
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 10
• Issue: 4
• Start Page: e0122136
• End Page: e0122136
• Grant/Funding Information: This work was supported, in part, by National Institutes of Health grants UL1 TR000454 (Atlanta Clinical and Translational Science Institute), T32 AA13528 (JAK), K23 AI103044 (RRK), T32 DK007298-32S1 and K01 DK102851 (JAA), K23 AR054334 (VT), K24 DK096574 (TRZ), R01 FD-003440 (GSM) and R21 HL110044 (GSM, TRZ).; The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Research Categories: Health Sciences, General; Health Sciences, Public Health

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.