• Nancy Lange, Augusto A Litonjua, Fiona K Gibbons, Edward Giovannucci, and Kenneth B Christopher.
• Pulmonary Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
• Am. J. Med. 2013 Jul 1;126(7):640.e19-27.

ObjectiveThe study objective was to examine the association between pre-hospital serum vitamin D concentration and mortality after hospitalization.MethodsWe performed a retrospective cohort study in 2 tertiary hospitals in Boston, Mass, on 23,603 patients aged ≥18 years in whom 25(OH)D was measured before hospitalization between 1993 and 2010. The main outcome measures were all-cause mortality by day 30 post-hospital admission, in-hospital mortality, and community-acquired bloodstream infection.ResultsCompared with patients with pre-hospital 25(OH)D ≥30 ng/mL, patients with pre-hospital 25(OH)D ≤15 ng/mL or 15 to 30 ng/mL have higher odds of mortality 30 days after hospital admission. After adjustment for age, gender, race, Deyo-Charlson index, season, type (surgical vs medical), creatinine, blood urea nitrogen, hematocrit, and time between 25(OH)D draw and hospital admission, the adjusted odds ratio (OR) of 30-day mortality in patients with 25(OH)D ≤15 ng/mL is 1.45 (95% confidence interval [CI], 1.21-1.74; P<.0001) and the adjusted OR of 30-day mortality in patients with 25(OH)D 15 to 30 ng/mL is 1.30 (95% CI, 1.10-1.54; P = .003) both compared with patients with pre-hospital 25(OH)D ≥30 ng/mL. In a subgroup analysis of patients who had blood cultures drawn (n = 5628), pre-hospital serum 25(OH)D ≤15 ng/mL was associated with increased odds of community-acquired bloodstream infection (adjusted OR, 1.29; 95% CI, 1.06-1.57; P = .01) relative to patients with 25(OH)D ≥30 ng/mL.ConclusionsAnalysis of 23,603 hospitalized patients identified both 25(OH)D ≤15 ng/mL and 25(OH)D 15 to 30 ng/mL before hospital admission as associated with the odds of all-cause patient mortality at 30 days after hospitalization. In addition, pre-hospital serum 25(OH)D ≤15 ng/mL is significantly associated with the odds of community-acquired bloodstream infection.Copyright © 2013 Elsevier Inc. All rights reserved.

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