Serum Vitamin D in Patients with Chronic Obstructive Lung Disease Does Not Correlate with Mortality – Results from a 10-Year Prospective Cohort Study

Abstract

BackgroundRecent studies have found vitamin D (25-OHD) deficiency and insufficiency to be common among patients with COPD. Serum level of 25-OHD seems to correlate to pulmonary function, COPD disease staging, and increased susceptibility to respiratory infections. We wanted to investigate whether vitamin D deficiency or insufficiency was associated with mortality rate in patients suffering from advanced COPD.Methods25-OHD serum levels were measured in 462 patients suffering from moderate to very severe COPD. Patients were stratified into three groups according to serum levels of 25-OHD. Outcome measure was mortality in a 10 year follow-up period. Kaplan-Meier curves (KM) were plotted and mortality hazard ratios (HR) were calculated using Cox Proportional Hazard regression (Cox PH).ResultsSerum 25-OHD deficiency and insufficiency were prevalent. We were unable to demonstrate any association between baseline serum levels of 25-OHD and mortality rate. We found an association between mortality and age [HR 1.05 (CI 95%: 1.03–1.06)], Charlson score [HR 1.49 (CI 95%: 1.06–2.09)], increasing neutrophil count [HR 1.05 (CI 95%: 1.02–1.09)], severe [HR 1.41 (CI 95%: 1.06–1.86)]/very severe COPD [HR 2.19 (CI 95%: 1.58–3.02)] and a smoking history of more than 40 pack years [HR 1.27 (CI 95%: 1.02–1.70)].ConclusionsSerum level of 25-OHD does not seem to be associated with mortality rate, suggesting no or only a minor role of 25-OHD in disease progression in patients with moderate to very severe COPD.

The association between vitamin D and COPD risk, severity, and exacerbation: an updated systematic review and meta-analysis

“…Seven studies18,20,23,24,26,33,35 (2,091 COPD patients) investigated the association between serum vitamin D levels and COPD severity. All studies defined COPD severity based on the Global Initiative for Obstructive Lung Disease (GOLD) classification.…”

Lung function, 25-hydroxyvitamin D concentrations and mortality in US adults

“…These results are consistent with findings from three other observational studies with durations of follow-up ranging from 2 to 10 years that failed to find significant associations between concentrations of 25(OH)D and mortality. 26–28 Also, a clinical trial among patients with chronic obstructive pulmonary disease did not show that vitamin D supplementation lowered 1-year mortality. 37 Furthermore, concentrations of 25(OH)D have not been shown to be significantly associated with exacerbations.…”

“…However, this domain of research remains largely unexplored although recently several studies have failed to show that concentrations of 25(OH)D predicted mortality in patients with chronic obstructive pulmonary disease. 26–28 Thus, the objective of this study was to examine the prospective association between circulating concentrations of vitamin D (25 (OH)D) and all-cause mortality in a national sample of adults with obstructive lung function (LF). Secondary objectives included examining the prospective association between circulating concentrations of 25(OH)D and all-cause mortality among adults with restrictive LF (RLF) and among all participants.…”

One-year mortality after severe COPD exacerbation in Bulgaria

“…COPD patients with severe exacerbation have increased mortality rate. Among comorbidities, vitamin D deficiency and insufficiency, diabetes mellitus (DM), and metabolic syndrome (MS) are associated with increased mortality (Divo et al, 2012; Gudmundsson et al, 2006; Galassi, Reynolds & He, 2006; Mannino et al, 2008), but not in all studies (Benson et al, 2012; Schelini et al, 2012; Holmgaard et al, 2013). …”