Vitamin D when low increases risk of hospital-acquired infection after surgery

Vitamin D is crucial not only for the immune tolerance that opposes autoimmunity and allergy, but also for effective resistance to opportunistic infections. A study just published in JAMA Surgery (formerly Archives of Surgery) shows a link between pre-operative vitamin D levels and hospital-acquired infections. The authors associate vitamin D status with barrier integrity:

"Postoperative hospital-acquired infections (HAIs) may result from disruption of natural barrier sites. Recent studies have linked vitamin D status and barrier site integrity."

Their objective was to...

"...investigate the association between preoperative vitamin D status and the risk for HAIs."

They discriminated preoperative vitamin D (25-hydroxyvitamin D (25[OH]D) levels less than 30 ng/mL vs 30 ng/mL or greater in association with the risk for postoperative HAIs for 770 gastric bypass surgery patients over five years and found a distinct association:

"The risk for HAIs was 3-fold greater in patients with 25(OH)D levels less than 30 ng/mL vs 30 ng/mL or greater. Further adjustment for additional perioperative factors did not materially change this association. Locally weighted scatterplot smoothing analysis depicted a near inverse linear relationship between vitamin D status and the risk for HAIs for 25(OH)D levels around 30 ng/mL."

Clinical note: Patients should be supported in every relevant way prior to elective surgery to minimize complications and ensure the optimum outcome. I have for years never felt at ease without knowing that my patients anticipating surgery had adequate levels of vitamin D determined by measuring serum (25[OH]D.The authors cautiously conclude:

"In our patient cohort, a significant inverse association was observed between preoperative 25(OH)D levels and the risk for HAIs. These results suggest that preoperative 25(OH)D levels may be a modifiable risk factor for postoperative nosocomial infections."