Higher plasma vitamin D is associated with reduced risk of Clostridium difficile infection in patients with inflammatory bowel diseases

被引:59
作者
Ananthakrishnan, A. N. [1 ,2 ]
Cagan, A. [3 ]
Gainer, V. S. [3 ]
Cheng, S-C. [4 ]
Cai, T. [4 ]
Szolovits, P. [5 ]
Shaw, S. Y. [2 ,6 ]
Churchill, S. [7 ]
Karlson, E. W. [2 ,8 ]
Murphy, S. N. [2 ,4 ,9 ]
Kohane, I. [2 ,7 ,10 ]
Liao, K. P. [2 ,8 ]
机构
[1] Massachusetts Gen Hosp, Div Gastroenterol, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Boston, MA USA
[3] Partners HealthCare, Res IS & Comp, Charlestown, MA USA
[4] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
[5] MIT, Cambridge, MA 02139 USA
[6] Massachusetts Gen Hosp, Ctr Syst Biol, Boston, MA 02114 USA
[7] Brigham & Womens Hosp, Natl Ctr Biomed Comp I2b2, Boston, MA 02115 USA
[8] Brigham & Womens Hosp, Div Rheumatol Allergy & Immunol, Boston, MA 02115 USA
[9] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA
[10] Childrens Hosp, Boston, MA 02115 USA
基金
美国国家卫生研究院;
关键词
ULCERATIVE-COLITIS; CROHNS-DISEASE; D LEVEL; CATHELICIDIN; DIARRHEA; OUTCOMES; PEPTIDE; HEALTH; IMPACT; HOSPITALIZATION;
D O I
10.1111/apt.12706
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Patients with inflammatory bowel diseases (IBD) have an increased risk of clostridium difficile infection (CDI). Cathelicidins are anti-microbial peptides that attenuate colitis and inhibit the effect of clostridial toxins. Plasma calcifediol [25(OH)D] stimulates production of cathelicidins. Aim To examine the association between plasma 25(OH)D and CDI in patients with IBD. Methods From a multi-institutional IBD cohort, we identified patients with at least one measured plasma 25(OH)D. Our primary outcome was development of CDI. Multivariate logistic regression models adjusting for potential confounders were used to identify independent effect of plasma 25(OH)D on risk of CDI. Results We studied 3188 IBD patients of whom 35 patients developed CDI. Patients with CDI-IBD were older and had greater co-morbidity. The mean plasma 25(OH)D level was significantly lower in patients who developed CDI (20.4ng/mL) compared to non-CDI-IBD patients (27.1ng/mL) (P=0.002). On multivariate analysis, each 1ng/mL increase in plasma 25(OH)D was associated with a 4% reduction in risk of CDI (OR 0.96, 95% CI 0.93-0.99, P=0.046). Compared to individuals with vitamin D >20ng/mL, patients with levels <20ng/mL were more likely to develop CDI (OR 2.27, 95% CI 1.16-4.44). The mean plasma 25(OH)D in patients with CDI who subsequently died was significantly lower (12.8 +/- 8.1ng/mL) compared to those who were alive at the end of follow-up (24.3 +/- 13.2ng/mL) (P=0.01). Conclusions Higher plasma calcifediol [25(OH)D] is associated with reduced risk of C. difficile infection in patients with IBD. Further studies of therapeutic supplementation of vitamin D in patients with inflammatory bowel disease and C. difficile infection may be warranted.
引用
收藏
页码:1136 / 1142
页数:7
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