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Addition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired Pneumonia.
Clin Infect Dis. 2012 Aug 31;
Authors: Remmelts HH, van de Garde EM, Meijvis SC, Peelen EL, Damoiseaux JG, Grutters JC, Biesma DH, Bos WJ, Rijkers GT
Abstract
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.?Prospective cohort study in 272 hospitalized CAP-patients. 25-hydroxyvitamin D, leukocytes, C-reactive protein, total cortisol, the Pneumonia Severity Index (PSI) score and CURB-65 score were measured on admission. Major outcome measures were intensive care unit (ICU) admission and 30-day mortality.Results.?143 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% CI 0.57-0.80). 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 to the PSI score alone (AUC 0.83, 95% CI 0.71-0.94).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.
PMID: 22942205 [PubMed - as supplied by publisher]