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Clin Nutr. 2016 Apr;35(2):514-521. doi: 10.1016/j.clnu.2015.03.020. Epub 2015 Apr 14.

Increases in pre-hospitalization serum 25(OH)D concentrations are associated with improved 30-day mortality after hospital admission: A cohort study.

Author information

1
Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Austria.
2
Channing Division of Network Medicine and Pulmonary and Critical Care Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
3
Department of Medicine, Okinawa Hokubu Prefectural Hospital, Okinawa, Japan.
4
Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
5
Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
6
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
7
Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA, USA.
8
The Nathan E. Hellman Memorial Laboratory, Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: kbchristopher@partners.org.

Abstract

CONTEXT:

Pre-hospital vitamin D status may be a modifiable risk factor for all-cause mortality among hospitalized patients.

OBJECTIVE:

To examine the association between increases in serum 25-hydroxyvitamin D [25(OH)D] levels during the year before hospitalization and risk of 30-day all-cause mortality after hospital admission.

DESIGN:

Retrospective cohort study.

SETTING:

Two Boston teaching hospitals.

PATIENTS OR OTHER PARTICIPANTS:

We studied 4344 adults hospitalized between 1993 and 2011 who had serum 25(OH)D concentrations measured at least twice within 7-365 days before the index hospitalization.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

The exposure of interest was change in pre-hospital serum 25(OH)D concentrations. The main outcome was 30-day all-cause mortality. We used mixed-effects logistic regression to describe how 30-day mortality differed with changes in pre-hospital 25(OH)D concentrations. Additionally, the odds of 30-day mortality in patients with pre-hospital 25(OH)D increases of ≥10 ng/mL was compared to that of patients with increases of <10 ng/mL.

RESULTS:

In a mixed-effect logistic regression model adjusted for age, gender, race, type (medical/surgical), Deyo-Charlson Index, creatinine and hematocrit, 30-day all-cause mortality rate was 8% (95%CI: 1-15) lower for each 10 ng/mL increase in pre-hospital 25(OH)D (P = 0.025) compared with the 30-day all-cause mortality rate in the entire cohort. In an adjusted logistic regression model, absolute changes of ≥10 ng/mL in patients with initial 25(OH)D concentrations < 20 ng/mL (n = 1944) decreased the odds of 30-day all-cause mortality by 48% (adjusted OR 0.52; 95%CI 0.30-0.93; P = 0.026) compared to patients with changes of <10 ng/mL.

CONCLUSIONS:

In patients with initial 25(OH)D < 20 ng/mL, subsequent improvements in vitamin D status before hospitalization are associated with decreased odds of 30-day all-cause mortality after hospital admission. A causal relation may not be inferred from this observational study.

KEYWORDS:

25-Hydroxy vitamin D; Hospitalization; Mortality

PMID:
25935851
DOI:
10.1016/j.clnu.2015.03.020
[Indexed for MEDLINE]

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