Preoperative vitamin D levels may influence post-surgical infection rate

Image: PD 

1. Higher (>30ng/mL) preoperative 25-hydroxyvitamin D (25(OH)D) levels were associated with a decreased risk of hospital-acquired infections (HAI) in patients undergoing laparoscopic roux-en-Y procedure. 

2. The association was dose-dependent but begins to plateau at 30 ng/mL 

Evidence Rating Level: 3 (Average)       

Study Rundown: This retrospective review of a single centre patient data registry compared levels of preoperative 25(OH)D and the rate of HAIs from patients undergoing laparoscopic roux-en-Y procedures. The study found a 3-fold increase in the risk of HAIs in patients with preoperative 25(OH)D levels less than 30ng/mL versus 30ng/mL or greater. The effect was dose dependent, and plateaued at preoperative 25(OH)D levels of 30ng/mL. The study only looked at one procedure performed in a narrow patient population, which reduced confounders related to different infection risks in various surgical procedures. However, the study design limits generalizability of findings to other surgical procedures and other patient populations. The clinical implication of this study is that 25(OH)D levels may be a modifiable risk factor for nosocomial, postoperative infections.

Click to read the study in JAMA Surgery

Relevant Reading: Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity

In-Depth [retrospective cohort]: This retrospective analysis of a matched-pairs cohort compared levels of preoperative 25(OH)D and the rate of HAI from patients undergoing laparoscopic roux-en-Y procedure in a single centre from 2007 to 2011. Overall, 770 patients met the inclusion criteria. A propensity score method was used to create a matched-pair cohort between patients with 25(OH)D levels of less than 30ng/mL and greater than 30ng/mL. This level was determined a priori and was previously shown to be the level of greatest immunomodulatory effect. Patients with preoperative 25(OH)D levels less than 30ng/mL had an OR of 3.05 (95% CI, 1.34-6.94) for HAI compared to 30ng/mL or higher. After adjusting for covariates, the OR was 2.92 (95%, 1.23-6.96). Weighted scatter plot smoothing plot showed a linear decrease in risk for HAI for 25(OH)D levels of 0 to 30ng/mL. There was progressive flattening of the curve between 30 to 50ng/mL with plateauing occurring at 50ng/mL.

Several proposed mechanisms of this protective association include the increased activation of immune cells such as interferon-γ-dependent T cell as well as upregulation of antimicrobial peptides cathelicidin (LL-37).

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