The Effect of the Systemic Inflammatory Response on Plasma Vitamin 25 (OH) D Concentrations Adjusted for Albumin

Abstract

BackgroundPlasma 25-hydroxyvitamin D (25(OH) D) deficiencies are associated with several diseases. The magnitude of systemic inflammatory response, as evidenced by C-reactive protein (CRP), is a major factor associated with lower 25(OH)D. Other aspects of the systemic inflammatory response may be important in determining plasma 25 (OH)D concentrations.AimTo examine the relationship between plasma 25(OH)D, CRP and albumin concentrations in two patient cohorts.Methods5327 patients referred for nutritional assessment and 117 patients with critical illness were examined. Plasma 25 (OH) D concentrations were measured using standard methods. Intra and between assay imprecision was <10%.ResultIn the large cohort, plasma 25 (OH) D was significantly associated with CRP (r s = −0.113, p<0.001) and albumin (r s = 0.192, p<0.001). 3711 patients had CRP concentrations ≤10 mg/L; with decreasing albumin concentrations ≥35, 25–34 and <25 g/l, median concentrations of 25 (OH) D were significantly lower from 35 to 28 to 14 nmol/l (p<0.001). This decrease was significant when albumin concentrations were reduced between 25–34 g/L (p<0.001) and when albumin <25 g/L (p<0.001). 1271 patients had CRP concentrations between 11–80 mg/L; with decreasing albumin concentrations ≥35, 25–34 and <25 g/l, median concentrations of 25 (OH) D were significantly lower from 31 to 24 to 19 nmol/l (p<0.001). This decrease was significant when albumin concentration were 25–34 g/L (p<0.001) and when albumin <25 g/L (p<0.001). 345 patients had CRP concentrations >80 mg/L; with decreasing albumin concentrations ≥35, 25–34 and <25 g/l, median concentrations of 25 (OH) D were not significantly altered varying from 19 to 23 to 23 nmol/l. Similar relationships were also obtained in the cohort of patients with critical illness.ConclusionPlasma concentrations of 25(OH) D were independently associated with both CRP and albumin and consistent with the systemic inflammatory response as a major confounding factor in determining vitamin D status.

Decreased preoperative serum 25-Hydroxyvitamin D levels in colorectal cancer are associated with systemic inflammation and serrated morphology

“…We report here of an association between low serum 25(OH)D levels and high scores of systemic inflammatory response in CRC. Similar association has been found in healthy adults and general patient material18. This association may reflect the immunomodulatory and immunosuppressive functions of vitamin D19, proinflammatory cytokines suppressing hepatic production of carrier proteins of vitamin D, or redistribution or consumption of vitamin D storages by the systemic inflammatory response18.…”

Plasma 25-hydroxyvitamin D and colorectal cancer risk according to tumour immunity status

“…The results remained very similar, and the P value for heterogeneity was 0.002 for the associations between plasma 25(OH)D and risk of CRC subtypes classified by intratumoural periglandular reaction ( Supplementary table s4 ). Given the potential influence of systemic inflammation on plasma 25(OH)D status and CRC development,[28, 29] we also adjusted for quartiles of each of the three inflammatory markers (i.e., CRP, IL6 and TNFRSF1B) in the multivariable model. As shown in Supplementary table s5 , the results did not essentially change, and the plasma 25(OH)D-CRC associations remained statistically significantly different according to the degree of intratumoural periglandular reaction ( P heterogeneity < 0.001).…”

Déficit de vitamina D y morbimortalidad en pacientes críticos pediátricos

“…Asimismo, se ha documentado una relación estadística y clínicamente significativa entre la concentración de albúmina y de proteína C reactiva y los niveles de vitamina D (213) .…”