Vitamin D deficiency is associated with increased mortality

A recent letter published in the New England Journal of Medicine emphasized the importance of treating Vitamin D deficiency in acute as well as chronic illness. Dr. Paul Lee and others followed a group of 42 patients in the ICU of St. Vincent's Hospital in Sydney, Australia over the course of a year.

When testing the "serum level of 25-hydroxyvitamin D" in 42 "referred patients", the mean was 41±22 nmol per liter (16±9 ng per milliliter). 45% were deficient in Vitamin D. The Simplified Acute Physiology Score II (SAPS II) "in patients with sufficient, insufficient, and deficient levels of vitamin D were 34±11, 45±13, and 51±13, with predicted mortality rates of 16%, 35%, and 45%, respectively."

The current study involving patients in the ICU reveals a high prevalence of hypovitaminosis D that was associated with adverse outcomes, independently of hypocalcemia and hypoalbuminemia.

Vitamin D deficiency is associated with increased mortality. This study cannot establish causality between hypovitaminosis D and adverse outcomes.

In a press release, Dr. Lee said, "There may be a bias, in that all patients were referred to endocrinology, so the numbers may not reflect the prevalence in a standard ICU cohort. However 45% is still a significant proportion. ...when we are very sick, the "sick organs" draw upon any vitamin D available to function properly, therefore we may need extra Vitamin D to maintain organ function during critical illness. However, at this stage, we don't know whether Vitamin D deficiency is just a marker of ill health, or whether it contributes to disease severity."

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Lee p, Eisman JA, Center JR (2009). Vitamin D Deficiency i Critically Ill Patient New England Journal of Medicine, 360 PMID: 19403914