Will vitamin D treat community-acquired pneumonia (CAP), as opposed to pneumonia acquired in the hospital? Together with influenza, CAP is the eighth leading cause of death in persons over 65 years of age in the United States, and is the leading infectious cause of death worldwide.
While we are waiting for adequate dosed randomized controlled trial of adjunctive (added on to antibiotics) vitamin D in CAP, we have seen several studies showing higher vitamin D levels reduce the risk of hospital acquired infections, infantile pneumonia, and lengthens life in the ICU. We also know it helps prevent and reduces the severity of viral respiratory infections.
A previous study of CAP showed that lower vitamin D levels (<12 ng/ml) were associated with a twelve times higher death rate, but no one has added vitamin D to a pneumonia rating scale to see if it adds to their predictive value.
Dr Hilde Remmelts and colleagues of St. Antonius Hospital in the Netherlands, recently published a study that also looked at vitamin D levels and CAP deaths. They used a “Pneumonia Severity Index” (PSI) to predict outcomes and tested to see if vitamin D levels improved the predictive values of the PSI.
Remmelts HH, van de Garde EM, Meijvis SC, Peelen EL, Damoiseaux JG, Grutters JC, Biesma DH, Bos WJ, Rijkers GT. Addition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired Pneumonia. Clin Infect Dis. 2012 Aug 31. [Epub ahead of print]
In a prospective cohort study of 272 hospitalized CAP patients, the authors measured vitamin D and studied ICU admission and 30‐day death rates. They found that 53% of CAP patients had vitamin D levels less than 20 ng/ml and 82% had levels below 30 ng/ml. Vitamin D deficiency was associated with an increased risk of ICU admission and increased 30-day mortality. Vitamin D levels were also an independent predictor of 30‐day mortality and improved the predictive value of the PSI significantly. Adverse outcomes were eight times higher in those with levels less than 10 ng/ml.
I was disappointed with their conclusion,
“In the case of a causal relationship, vitamin D supplementation might be a promising candidate for adjuvant treatment in CAP. Meanwhile, vitamin D status on presentation can be used as a prognostic marker.”
I saw not a word about treating those vitamin D deficient patients at risk of dying from pneumonia.