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. 2014 Feb 24;4(1):5.
doi: 10.1186/2110-5820-4-5.

Vitamin D deficiency and risk of acute lung injury in severe sepsis and severe trauma: a case-control study

Nicolas Barnett, Zhiguo Zhao, Tatsuki Koyama, David R Janz, Chen-Yu Wang, Addison K May, Gordon R Bernard, Lorraine B Ware  1
Affiliations

Vitamin D deficiency and risk of acute lung injury in severe sepsis and severe trauma: a case-control study

Nicolas Barnett et al. Ann Intensive Care. .

Abstract

Background: The aim of this study was to determine the association between 25-hydroxyvitamin D (25-OHD) levels at the onset of critical illness and the development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in patients with sepsis or trauma.

Methods: We performed two nested case-control studies of 478 patients with sepsis and trauma with or without ALI/ARDS admitted to the medical, surgical and trauma ICUs of a tertiary-care center. Cases consisted of patients with either sepsis or trauma and ALI/ARDS; controls consisted of equivalent numbers of matched patients with either sepsis or trauma alone. We measured serum 25-OHD levels the morning after ICU admission and used multivariable regression to assess the relationship between 25-OHD and diagnosis of ALI/ARDS during the first four ICU days, controlling for age, gender, diabetes, smoking status and season.

Results: 25-OHD levels did not differ between cases with ALI/ARDS and controls in either the sepsis or trauma cohorts. Using a conditional logistic regression model, sepsis patients during the winter season with higher 25-OHD levels were more likely to develop acute lung injury (odds ratio 1.68, 95% confidence interval of 1.05 to 2.69, P = 0.03). This association did not hold for the trauma cohort in either season. Sepsis and trauma patients had a lower risk of hospital mortality at higher 25-OHD levels but neither relationship reached significance. Higher one-year mortality after trauma was associated with lower 25-OHD levels (HR 0.50, CI 0.35,0.72 P = 0.001).

Conclusions: Serum 25-OHD measured early after admission to intensive care is not associated with the development of acute lung injury, hospital or one-year mortality in critically ill patients with sepsis although lower 25-OHD levels were associated with higher one-year mortality in patients with severe trauma.

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Figures

Figure 1
Figure 1
Box plot summary of 25-hydroxyvitamin D (25-OHD) levels by cohort and case-control status. Twenty-five-OHD levels were not significantly different between patients with or without acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Horizontal bars represent medians, boxes encompass the 25th to 75th percentile and error bars encompass the 10th to 90th percentile.
Figure 2
Figure 2
Forest plot summary of logistic regression analysis for risk of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in the sepsis cohort. Higher vitamin D levels in winter were associated with a higher odds ratio (OR) for developing ALI/ARDS: OR 1.68 (95% CI 1.054 to 2.69), (P = 0.03). OR (black dots) and the corresponding CIs (black lines) for the risk of ALI/ARDS for each covariate are shown.
Figure 3
Figure 3
Forest plot of logistic regression analysis for risk of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in the trauma cohort. Vitamin D levels were not associated with risk of ALI/ARDS in severe trauma. Odds ratio (black dots) and the corresponding confidence intervals (black lines) for the risk of ALI/ARDS for each covariate are shown.
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