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DOI: 10.1055/s-0036-1571527
Independent Associations of 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D with Postoperative Infections in Cardiac Surgical Patients
Objectives: Cardiac surgical patients are at an increased risk of developing infections. Although serious postoperative complications are uncommon, they are potentially devastating. Since vitamin D plays a prominent role in the innate immunity, low vitamin D status may influence the risk of infections.
Methods: We investigated in 3,340 consecutive cardiac surgical patients the association of circulating 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25[OH]2D) levels with postoperative infections. Vitamin D status was measured on the last preoperative day. The incidence of postoperative infections was assessed until discharge.
Results: Of the study cohort, 25.5% had deficient 25OHD levels (< 30 nmol/l) and 27.4% had 1,25(OH)2D levels below the reference range (< 41 pmol/l). The incidence of postoperative infections was 4.2% (n = 140). Broncho-pulmonary infection was most prevalent (n = 53), followed by thoracic wound infection (n = 24), sepsis (n = 17) and urinary tract infection (n = 17). The multivariable-adjusted odds ratio (OR) of infection in patients with deficient 25OHD levels (reference category: 75–100 nmol/l) was = 2.31 (95%CI: 1.16–5.06). With respect to 1,25(OH)2D, the multivariable-adjusted OR of infection in the lowest 1,25(OH)2D category (reference category: > 60 pmol/l) was = 1.81 (95%CI:1.21–2.72).
Conclusions: Data demonstrate that in cardiac surgical patients vitamin D deficiency is independently associated with the risk of infection. If confirmed in randomized controlled trials, administration of vitamin D (metabolites) could be considered as an adjunctive measure for infection prophylaxis.