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- Title
Addition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired Pneumonia.
- 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.
- Abstract
Vitamin D deficiency is associated with adverse clinical outcome in community-acquired pneumonia. Vitamin D status determined on hospital admission is a predictor of 30-day mortality and adds prognostic value to other biomarkers and prognostic scores, in particular the Pneumonia Severity Index score.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.
- Subjects
VITAMIN D deficiency; COMMUNITY-acquired pneumonia; BIOMARKERS; LEUCOCYTES; INTENSIVE care units; PROGNOSIS
- Publication
Clinical Infectious Diseases, 2012, Vol 55, Issue 11, p1488
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cis751