The Role of Vitamin D3 as an Independent Predicting Marker for One-Year Mortality in Patients with Acute Heart Failure

Abstract

Background: Deficiency in vitamin D3 and its metabolites has been linked to dismal outcomes in patients with chronic diseases, including cardiovascular disease and heart failure (HF). It remains unclear if a vitamin D3 status is a prognostic feature in patients with acute decompensated HF. Methods: We assessed serum levels of 25-OH-vitamin D3 and 1,25-(OH)2-vitamin D3 in 139 patients with acute HF who had been admitted to the intermediate care unit of a maximum care hospital. The follow-up period was one year. After exclusion of patients with sampling errors and those who were lost to follow-up, 118 patients remained in the final study cohort. Outcome estimates by 25-OH-vitamin D3 and 1,25-(OH)2-vitamin D3 levels were compared to the Seattle Heart Failure (SHF) Model. Results: More than two-thirds (79.7%) of the patients showed inadequate 25-OH-vitamin D3 levels (i.e., <30 ng/mL) upon admission. Low levels of 1,25-(OH)2-vitamin D3 (i.e., <19.9 pg/mL) were observed in 16.1% of patients. Of the 118 HF patients, 22 (19%) died during the following 12 months. There were no differences in vitamin D3 levels between patients who died and those who survived, neither in 25-OH-vitamin D3 (23.37 ± 19.14 ng/mL vs. 19.11 ± 12.25 ng/mL; p = 0.19) nor in 1,25-(OH)2-vitamin D3 levels (31.10 ± 19.75 ng/mL vs. 38.25 ± 15.73 ng/mL; p = 0.02); therefore, vitamin D3 levels alone did not predict one-year survival (AUC [25-OH-vitamin D3] 0.50; 95% CI 0.34–0.65; AUC [1,25-(OH)2-vitamin D3] 0.62; 95% CI 0.48–0.76). Moreover, whilst the SHF model exhibited acceptable discriminatory ability for predicting one-year mortality (AUC 0.79; 95% CI 0.66–0.91), adding vitamin D levels on admission to the SHF score did not improve its discriminatory value. Conclusion: Our data do not support the use of vitamin D3 screening in patients admitted with acute decompensated HF to aid prognostication.

Vitamin D, Cellular Senescence and Chronic Kidney Diseases: What Is Missing in the Equation?

“…Many observational studies emphasize the association between 25(OH)D levels and cardiovascular disease, atherosclerosis, hypertension and heart disease in CKD patients and the elderly [ 145 ]. Vitamin D deficiency was an independent predictor of mortality in patients with or without heart failure [ 146 , 147 , 148 , 149 ]. It was suggested that seasonal fluctuations in mortality (i.e., decreased CVD-related deaths in the summer and increased deaths in the winter) might be related to the lower vitamin D levels in the blood during winter [ 150 ].…”

The Importance of PTH for Heart Failure. Comment on Thiele et al. The Role of Vitamin D3 as an Independent Predicting Marker for One-Year Mortality in Patients with Acute Heart Failure. J. Clin. Med. 2022, 11, 2733

“…Thus, we suggest that the authors of Ref. [ 1 ] reanalyze the results of their study in terms of PTH rather than only 25(OH)D concentrations. PTH (parathormone) concentrations are reported in Table 1 (36.50 ± 29.64 pg/mL).…”

“…The communication by Thiele et al reported that there were no significant differences in serum 25-hydroxyvitamin D (25(OH)D) for the 22 of 118 acute heart failure (HF) patients, 71% with de novo HF and 29% with chronic HF, who died within 12 months after admission to the intermediate care unit of a maximum care hospital in Germany compared to those who survived [ 1 ]. The authors noted that this outcome differed from what was expected from the Seattle Heart Failure Model [ 2 ].…”