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

Background: Deficiency in vitamin D-3 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 D-3 status is a prognostic feature in patients with acute decompensated HF. Methods: We assessed serum levels of 25-OH-vitamin D-3 and 1,25-(OH)(2)-vitamin D-3 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 D-3 and 1,25-(OH)(2)-vitamin D-3 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 D-3 levels (i.e., <30 ng/mL) upon admission. Low levels of 1,25-(OH)(2)-vitamin D-3 (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 D-3 levels between patients who died and those who survived, neither in 25-OH-vitamin D-3 (23.37 +/- 19.14 ng/mL vs. 19.11 +/- 12.25 ng/mL; p = 0.19) nor in 1,25-(OH)(2)-vitamin D-3 levels (31.10 +/- 19.75 ng/mL vs. 38.25 +/- 15.73 ng/mL; p = 0.02); therefore, vitamin D-3 levels alone did not predict one-year survival (AUC [25-OH-vitamin D-3] 0.50; 95% CI 0.34-0.65; AUC [1,25-(OH)2-vitamin D-3] 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 D-3 screening in patients admitted with acute decompensated HF to aid prognostication.