Vitamin D Deficiency Linked to Worse IBD Hospital Outcomes

Saba Altarawneh, MD

Credit: ResearchGate

Patients with inflammatory bowel disease (IBD) who are deficient in vitamin D may face worse outcomes including more severe hospitalizations and risk of colectomy, according to findings from a trial presented at the American College of Gastroenterology (ACG) 2024 Scientific Sessions in Philadelphia, PA, this week.

Investigators from West Virginia reported data at ACG 2024 expanding on the known association between IBD and vitamin D deficiency, showing that patients with the latter are at significantly greater risk of severe outcomes with the former. As clinicians continue to interpret the causal or correlative relationship between IBD and vitamin D levels, the findings emphasize the need to measure the latter in all at-risk patients.

Investigators led by Saba Altarawneh, MD, of the Wright Center for Graduate Medical Education in Huntington, explored the linkage between vitamin D deficiency and specifically, hospitalization outcomes in patients with IBD.

“Vitamin D deficiency has been linked to IBD, whether vitamin D deficiency is a cause or a consequence of the disease is not well-known yet,” they wrote. “Moreover, there is a critical gap in understanding the potential impact of vitamin D status on disease severity and patient outcomes.”

Prior clinical research has noted the influence of vitamin D on microbiota dysbiosis—a trait it shares with IBD.

“Vitamin D deficiency is correlated with disease activity and its administration targeting a concentration of 30 ng/mL may have the potential to reduce disease activity,” Battistini et al wrote. “Moreover, vitamin D receptor regulates functions of T cells and Paneth cells and modulates release of antimicrobial peptides in gut microbiota-host interactions.”

Altarawneh and colleagues used data from the National Inpatient Sample (NIS) collected from 2016 – 2018, to identify patients with a primary discharge diagnosis of IBD. They distinguished such patients based on whether they had a vitamin D deficiency or not. Further comparisons considered patients’ demographics, comorbidity scores, long-term use of antibiotics or steroids, and characteristics of hospitalization.

The analysis included 540,650 patients admitted to the hospital primarily due to IBD in the selected time period. Among them, 16,310 had a concomitant diagnosis of vitamin D deficiency. Investigators observed that patients with both IBD and vitamin D deficiency were more likely to be White, female, and have a higher probability of long-term steroid use.

Patients with IBD and vitamin D deficiency experienced a 1.31-day longer mean hospital stay (95% CI, 1.07 – 1.55; P <.001) and $9215.33-greater mean hospital cost (95% CI, 6736.69 – 11,693.96; P <.001) versus patients with IBD and without vitamin D deficiency. They additionally had an 18% increased risk of colectomy (OR, 1.18; 95% CI, 1.04 – 1.33; P = .01).

That said, investigators observed no significant differences in in-hospital mortality (OR, 0.79; 95% CI, 0.35 – 1.77; P = .56) nor venous thromboembolism risk (OR, 1.06; 95% CI, 0.78 – 1.42; P = .76) based on IBD patients’ vitamin D levels.

“Vitamin D deficiency is prevalent in IBD patients in multiple studies,” the team observed. “Small studies in <20 patients have shown that vitamin D supplementation has been associated with better outcomes in IBD patients with vitamin deficiency.”

Investigators concluded vitamin D deficiency in patients with IBD correlated with longer hospital stays, increased hospital charges and increased odds of colectomy. They wrote the findings emphasize “the need to establish a standard clinical practice to measure vitamin D in this population.”

References

1. ^{Altarawneh S, El-Dallal M, Bills E, Karki S, et al. Vitamin D Deficiency Is Associated With Worsening Hospitalization Outcomes for Patients With Inflammatory Bowel Disease in the United States. Abstract presented at: American College of Gastroenterology (ACG) 2024 Scientific Sessions. Philadelphia, PA. October 25 – 30, 2024.}
2. ^{Battistini C, Ballan R, Herkenhoff ME, Saad SMI, Sun J. Vitamin D Modulates Intestinal Microbiota in Inflammatory Bowel Diseases. Int J Mol Sci. 2020 Dec 31;22(1):362. doi: 10.3390/ijms22010362. PMID: 33396382; PMCID: PMC7795229.}