Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2 D are associated with disease severity

• Published in: Respiratory research Vol. 15; no. 1; p. 53
• Main Authors: Pletz, Mathias W, Terkamp, Christoph, Schumacher, Ulrike, Rohde, Gernot, Schütte, Hartwig, Welte, Tobias, Bals, Robert
• Format: Journal Article
• Language: English
• Published: England BioMed Central 27.04.2014; BioMed Central Ltd
• Subjects: Adult; Age; Aged; Biomarkers - blood; Cohort Studies; Community-Acquired Infections - blood; Community-Acquired Infections - diagnosis; Community-Acquired Infections - epidemiology; Cross-Sectional Studies; Dihydrotachysterol - analogs & derivatives; Dihydrotachysterol - blood; Disease; Female; Gastroenterology; Hepatology; Hospitals; Humans; Immune system; Influenza; Internal medicine; Male; Medicine; Middle Aged; Older people; Pneumonia - blood; Pneumonia - diagnosis; Pneumonia - epidemiology; Prospective Studies; Seasons; Severity of Illness Index; Streptococcus infections; Studies; Tuberculosis; Vitamin D; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - diagnosis; Vitamin D Deficiency - epidemiology; Vitamin deficiency
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/1465-9921-15-53

We aimed to explore the association between vitamin D levels and the severity, mortality and microbiological etiology of community-acquired pneumonia. Vitamin D levels (both, the reservoir form 25-OH and the activated form 1,25-OH2) of 300 randomly selected patients with community-acquired pneumonia due to pre-specified pathogens included in the German competence network (CAPNETZ) study were measured. Prior to statistical analysis, values of 25-OH and 1,25-OH2 were power-transformed to achieve parametric distribution. All further analyses were performed with seasonally and age adjusted values. There was only a modest (Spearman Coefficient 0.38) positive correlation between 25-OH and 1,25-OH2. For 1,25-OH2 but not 25-OH, the general linear model revealed a significant inverse correlation between serum concentration and CURB score (p = 0.011). Liver and respiratory co-morbidity were associated with significantly lower 25-OH values and renal co-morbidity with significantly lower 1,25-OH2 values. No significant differences of 1,25-OH2 or 25-OH between different pathogens (influenza virus, Legionella spp., Streptococcus pneumoniae) were detected. For 1,25-OH2, we found a significant and independent (controlled for age, season and pathogen) negative correlation to pneumonia severity. Therefore, supplementation of non-activated vitamin D to protect from pneumonia may be non-sufficient in patients that have a decreased capacity to hydroxylate 25-OH to 1,25-OH2.