Original scientific paper
https://doi.org/10.3325/cmj.2016.57.276
Vitamin D levels and their associations with survival and major disease outcomes in a large cohort of patients withchronic graft-vs-host disease
Mašenjka Katić
orcid.org/0000-0001-7237-697X
; Experimental Transplantation and Immunology Branch, NCI, NIH,Bethesda, MD, USA
Filip Pirsl
; Experimental Transplantation and Immunology Branch, NCI, NIH,Bethesda, MD, USA
Seth M. Steinberg
; Biostatistics and Data Management Section, NCI, NIHRockville, MD, USA
Marnie Dobbin
; Clinical Nutrition Department Clinical Center, NIH, Bethesda, MD,USA
Lauren M. Curtis
; Experimental Transplantation and Immunology Branch, NCI, NIH,Bethesda, MD, USA
Dražen Pulanić
; Division of Hematology Department of Internal Medicine,University Hospital Center Zagreb,Zagreb, Croatia
Lana Desnica
; Division of Hematology Department of Internal Medicine,University Hospital Center Zagreb,Zagreb, Croatia
Irina Titarenko
; Center for Cancer Research, NIH, Bethesda, MD, USA
Abstract
Aim To identify the factors associated with vitamin D status
in patients with chronic graft-vs-host disease (cGVHD) and
evaluate the association between serum vitamin D (25(OH)
D) levels and cGVHD characteristics and clinical outcomes
defined by the National Institutes of Health (NIH) criteria.
Methods 310 cGVHD patients enrolled in the NIH cGVHD
natural history study (clinicaltrials.gov: NCT00092235)
were analyzed. Univariate analysis and multiple logistic
regression were used to determine the associations between
various parameters and 25(OH)D levels, dichotomized
into categorical variables: ≤20 and >20 ng/mL, and
as a continuous parameter. Multiple logistic regression was
used to develop a predictive model for low vitamin D. Survival
analysis and association between cGVHD outcomes
and 25(OH)D as a continuous as well as categorical variable:
≤20 and >20 ng/mL; <50 and ≥50 ng/mL, and among
three ordered categories: ≤20, 20-50, and ≥50 ng/mL, was
performed.
Results 69 patients (22.3%) had serum 25(OH)D ≤20 ng/
mL. Univariate analysis showed that supplement intake,
nutritional status (severely malnourished, moderately malnourished,
well-nourished), race (African-American, other),
and estimated creatinine clearance (eCCr) were associated
with 25(OH)D levels. A predictive model was developed
based on supplement intake, nutritional status, race, and
eCCr, accurately predicting 77.9% of patients with 25(OH)
D ≤20 and 65.2% of those with 25(OH)D >20 ng/mL. No association
was found between vitamin D and major cGVHD
characteristics, but patients with 25(OH)D ≤20 ng/mL had
somewhat decreased survival.
Conclusion Nutritional status and adequate supplementation
are important to maintain 25(OH)D >20 ng/mL in
cGVHD patients. Intervention studies and more research is
needed to reveal the underlying mechanism of vitamin D
metabolism in cGVHD setting.
Keywords
Hrčak ID:
170167
URI
Publication date:
15.6.2016.
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