Relationship Between Vitamin D Status and ICU Outcomes in Veterans Jason D. McKinney, DO, Beth A. Ba1ley, PhD, Linda H. Garrett, PhD, Prith Peiris, MD, Todd Manning, MS, and Alan N. Peiris, MD, PhD, MRCP Objective: Vitamin D deficiency remains a poorly rec ognized pandemic and is closely linked to increased health care costs in veterans. Projected health care needs in veterans are expected to increase over the next decade. Intensive care unit (KU) costs contribute significantly to hospital costs and stem from interven tion services and management of sepsis including nos ocomial infections. Vitamin D has immunomodulating and antimicrobial properties through antimicrobial peptides such as cathelicidin. Design/Methods: A retrospective study was under taken to evaluate if vitamin D deficiency was associ ated with less than optimal ICU outcomes in veterans. The study included 136 veterans with 25(OH)D levels drawn within a month of admission to ICU. Results: The average 25(OH)D level was 24.6 ng/mL (normal range 30—100) with 38% of patients falling in the vitamin D—deficient category (<20 nglmL). ICU survivors had a significantly lower rate of vitamin D deficiency compared with nonsurvivors (28% versus 53%). Twenty-nine percent of vitamin D—replete patients were in ICU 3 days or more, whereas 58% of patients with vitamin D deficiency stayed in ICU 3 days or longer. This difference was highly significant translating to twofold increased risk (2.0 Relative Risk [RR]) for 3-day or longer stay in ICU for patients with vitamin D deficiency. Moreover, the risk of death was significantly higher in ICU patients with vitamin D deficiency (RR 1.81). Conclusion: A vitamin D—replete state may reduce costs and confer survival advantages in critical illness. We recommend that 25(OH)D levels be rou tinely checked and deficiencies treated in ICU patients. (i Am Med Dir Assoc 2011; 12: 208—211) Keywords: Vitamin D; public health; intensive care; mortality; morbidity Costs associated with intensive care stays (ICLi) are sub stantial with hospital ICU costs up to 700% greater than non-ICU costs. 1 These costs are based on a variety of factors including length of stay and intervention services with the lat ter typically a more accurate predictor of costs than severity of illness scores. 2 Weber et al’ have indicated that ICU drug costs account for up to 38% of total hospital drug costs and have increased at a rate greater than non-ICU drug charges. Invasive bacterial and fungal sepsis, 4 especially respiratory Mountain Home VAMC, Mountain Home, TN (J.D.M., TM., A.N.P.); and East ern Tennessee State University (ETSU), Department of Family Medicine, Johnson City, TN (B.A.B.); ETSU Department of Nursing, Johnson City, TN (L.H.Gj; Mayo Clinic, FL (PP.), and ETSU Department of Internal Medicine, Johnson City, TN (J.D.M., A.N.P.). This material is the result of work supported with resources and the use of facilities at Mountain Home VA Medical Center in Johnson City, Tennessee. The contents of this paper do not represent the views of the Department of Veterans Affairs or the US government. Address correspondence to Alan N. Peiris, MD, PhD, MRCP (UK), Chief of Endocrinology, Medicine service-il, Mountain Home VAMC, Mountain Home, TN 37684. E-mail: Alan.Peiris@va.gov Copyright ©201 1 American Medical Directors Association DOI:1O.10161j.jamda.2010.04.004 tract infections 5 and poor nutritional status may predict ICU-related health care costs and outcomes. Moreover, noso comial infections, such as methicillin-resistant Staphylococcus aureus (MRSA), increase health care costs via antimicrobial therapy and extended stays in hospital units. 7 ’ 8 Furthermore, obesity may predict ICU mortality 9 and obesity has been asso ciated with greater degrees of vitamin D insufficiency,’ 0 Vitamin D deficiency is a poorly recognized pandemic 1 I that is associated with increased health care costs.’ 2 Additionally, even modest vitamin D replacement has been shown to decrease morbidity and increase longevity.’ 3 Recent data suggest that vitamin D may boost innate im munity through expression of antimicrobial peptides such as beta defensin 2’ and cathelicidin)’ Vitamin D deficiency has been linked to adverse and more costly outcomes in vet erans with Clostridium difficile and methicillin-sensitive Staphylococcus aureus infections.’ 6 Veterans present a unique population with a high prevalence of vitamin D deficiency’ 7 and increased health care needs. The authors hypothesize that vitamin D deficiency is associated with less than optimal outcomes in critical care settings. The present study was undertaken to evaluate the relationship of vitamin D status to ICU outcomes among veterans. 208 McKinneyetal JAMDA — March 2011