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Multicenter Study
. 2014 May;39(10):1136-42.
doi: 10.1111/apt.12706. Epub 2014 Mar 18.

Higher plasma vitamin D is associated with reduced risk of Clostridium difficile infection in patients with inflammatory bowel diseases

A N Ananthakrishnan  1 , A Cagan, V S Gainer, S-C Cheng, T Cai, P Szolovits, S Y Shaw, S Churchill, E W Karlson, S N Murphy, I Kohane, K P Liao
Affiliations
Multicenter Study

Higher plasma vitamin D is associated with reduced risk of Clostridium difficile infection in patients with inflammatory bowel diseases

A N Ananthakrishnan et al. Aliment Pharmacol Ther. 2014 May.

Abstract

Background: Patients with inflammatory bowel diseases (IBD) have an increased risk of clostridium difficile infection (CDI). Cathelicidins are anti-microbial peptides that attenuate colitis and inhibit the effect of clostridial toxins. Plasma calcifediol [25(OH)D] stimulates production of cathelicidins.

Aim: To examine the association between plasma 25(OH)D and CDI in patients with IBD.

Methods: From a multi-institutional IBD cohort, we identified patients with at least one measured plasma 25(OH)D. Our primary outcome was development of CDI. Multivariate logistic regression models adjusting for potential confounders were used to identify independent effect of plasma 25(OH)D on risk of CDI.

Results: We studied 3188 IBD patients of whom 35 patients developed CDI. Patients with CDI-IBD were older and had greater co-morbidity. The mean plasma 25(OH)D level was significantly lower in patients who developed CDI (20.4 ng/mL) compared to non-CDI-IBD patients (27.1 ng/mL) (P = 0.002). On multivariate analysis, each 1 ng/mL increase in plasma 25(OH)D was associated with a 4% reduction in risk of CDI (OR 0.96, 95% CI 0.93-0.99, P = 0.046). Compared to individuals with vitamin D >20 ng/mL, patients with levels <20 ng/mL were more likely to develop CDI (OR 2.27, 95% CI 1.16-4.44). The mean plasma 25(OH)D in patients with CDI who subsequently died was significantly lower (12.8 ± 8.1 ng/mL) compared to those who were alive at the end of follow-up (24.3 ± 13.2 ng/mL) (P = 0.01).

Conclusions: Higher plasma calcifediol [25(OH)D] is associated with reduced risk of C. difficile infection in patients with IBD. Further studies of therapeutic supplementation of vitamin D in patients with inflammatory bowel disease and C. difficile infection may be warranted.

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Conflict of interest statement

Financial conflicts of interest: None

Figures

Figure 1
Figure 1
Plasma 25-hydroxy vitamin D levels in patients with inflammatory bowel disease, stratified by history of clostridium difficile infection
Figure 2
Figure 2
Plasma 25(OH)D and long-term mortality in IBD patients with Clostridium difficile infection
See this image and copyright information in PMC

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