Addition of 25-hydroxyvitamin D levels to the Deyo-Charlson Comorbidity Index improves 90-day mortality prediction in critically ill patients

نویسندگان

  • Bisundev Mahato
  • Tiffany M. N. Otero
  • Carrie A. Holland
  • Patrick T. Giguere
  • Ednan K. Bajwa
  • Carlos A. Camargo
  • Sadeq A. Quraishi
چکیده

BACKGROUND The Deyo-Charlson Comorbidity Index (DCCI) has low predictive value in the intensive care unit (ICU). Our goal was to determine whether addition of 25-hydroxyvitamin D (25OHD) levels to the DCCI improved 90-day mortality prediction in critically ill patients. METHODS Plasma 25OHD levels, DCCI, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were assessed within 24 h of admission in 310 ICU patients. Receiver operating characteristic curves of the prediction scores, without and with the addition of 25OHD levels, for 90-day mortality were constructed and the areas under the curve (AUC) were compared for equality. RESULTS Mean (standard deviation) plasma 25OHD levels, DCCI, and APACHE II score were 19 (SD 8) ng/mL, 4 (SD 3), and 17 (SD 9), respectively. Overall 90-day mortality was 19 %. AUC for DCCI vs. DCCI + 25OHD was 0.68 (95 % CI 0.58-0.77) vs. 0.75 (95 % CI 0.67-0.83); p < 0.001. AUC for APACHE II vs. APACHE II + 25OHD was 0.81 (95 % CI 0.73-0.88) vs. 0.82 (95 % CI 0.75-0.89); p < 0.001. There was a significant difference between the AUC for DCCI + 25OHD and APACHE II + 25OHD (p = 0.04) but not between the AUC for DCCI + 25OHD and APACHE II (p = 0.12). CONCLUSIONS In our cohort of ICU patients, the addition of 25OHD levels to the DCCI improved 90-day mortality prediction compared to the DCCI alone. Moreover, the predictive capability of DCCI + 25OHD was comparable to that of APACHE II. Future prospective studies are needed to validate our findings and to determine whether the use of DCCI + 25OHD can influence clinical decision-making.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

The Deyo-Charlson and Elixhauser-van Walraven Comorbidity Indices as predictors of mortality in critically ill patients

OBJECTIVES Our primary objective was to compare the utility of the Deyo-Charlson Comorbidity Index (DCCI) and Elixhauser-van Walraven Comorbidity Index (EVCI) to predict mortality in intensive care unit (ICU) patients. SETTING Observational study of 2 tertiary academic centres located in Boston, Massachusetts. PARTICIPANTS The study cohort consisted of 59,816 patients from admitted to 12 IC...

متن کامل

Author's response to reviews Title: Mortality after Primary Shoulder Arthroplasty: An analysis of 4,019 patients from 1976-2008 Authors:

“BMI ≥ 30 was associated with lower risk of 90-day mortality (OR, 0.25; 95% CI:0.08,0.78). In univariate analyses, patients undergoing TSA had significantly lower 90-day mortality of 0.4% (8/2,580) compared to 1% in HHR (20/1,411) (odds ratio, 0.22 (95% CI: 0.10, 0.50); p=0.0003). Conclusions: 90-day mortality following shoulder arthroplasty was low. An underlying diagnosis of tumor, higher com...

متن کامل

Association between prehospital vitamin D status and incident acute respiratory failure in critically ill patients: a retrospective cohort study

OBJECTIVE We hypothesise that low 25-hydroxyvitamin D (25(OH)D) levels before hospitalisation are associated with increased risk of acute respiratory failure. DESIGN Retrospective cohort study. SETTING Medical and Surgical Intensive care units of two Boston teaching hospitals. PATIENTS 1985 critically ill adults admitted between 1998 and 2011. INTERVENTIONS None. MEASUREMENTS AND MAIN...

متن کامل

Ninety day mortality and its predictors after primary shoulder arthroplasty: an analysis of 4,019 patients from 1976-2008

BACKGROUND Examine 90-day postoperative mortality and its predictors following shoulder arthroplasty METHODS We identified vital status of all adults who underwent primary shoulder arthroplasty (Total shoulder arthroplasty (TSA) or humeral head replacement (HHR)) at the Mayo Clinic from 1976-2008, using the prospectively collected information from Total Joint Registry. We used univariate logi...

متن کامل

Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients

INTRODUCTION Decreased production of cathelicidin antimicrobial protein-18 (hCAP18) has been proposed to be a key mechanism linking decreased 25-hydroxyvitamin D (25D) levels with adverse outcomes among critically ill patients. However, few studies in humans have directly assessed plasma hCAP18 levels, and no study has evaluated the association between hCAP18 levels and adverse outcomes among c...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:

دوره 4  شماره 

صفحات  -

تاریخ انتشار 2016