Impact of Severe Vitamin D Deficiency on Antibiotic Use in Hospitalized COPD Patients with Exacerbations: A Retrospective Analysis

Boyu Li,1 Meishan Liu,2 Bingqing Ren,1 Han Wu,1 Yi Zhang,1 Zhuoling An,1 Kewu Huang2 1Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Kewu Huang, Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel/Fax +86 010 85231167, Email [email protected] Zhuoling An, Department of Pharmacy, Beijing Chao-yang Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel/Fax +86 010 85231362, Email [email protected]: Exacerbations of chronic obstructive pulmonary disease (ECOPD) often require antibiotic treatment. Vitamin D deficiency has been implicated in influencing the outcomes of ECOPD; however, its role in antibiotic usage during hospitalization remains unclear.Patients and Methods: We conducted a retrospective analysis of 125 hospitalized ECOPD patients, stratified into two groups based on the presence of severe vitamin D deficiency (SVDD, 25-hydroxyvitamin D < 10 ng/mL) and non-severe vitamin D deficiency (NSVDD). Clinical outcomes, including duration of antibiotic treatment, cumulative defined daily doses (cDDDs), hospital length of stay (LOS) and associated costs, were compared between subgroups. Multivariate linear regression was used to assess the association between 25-hydroxyvitamin D levels and antibiotic use, adjusting for demographic and clinical variables.Results: Patients with SVDD exhibited significantly longer durations of antibiotic use (13.50 vs. 11.00 days, P=0.023), higher cDDDs (16.16 vs. 12.00, P=0.012) and longer LOS (15.00 vs .12.00, P=0.026) compared to those with NSVDD. Patients with SVDD and pneumonia had more antibiotics use, longer LOS and higher cost than those with NSVDD and AECOPD (P< 0.05). Multivariate linear regression analysis revealed that lower 25-hydroxyvitamin D levels were independently associated with increased antibiotic duration (coefficient − 0.20, 95% CI − 0.32, − 0.08, P< 0.001) and higher cDDDs (coefficient − 0.24, 95% CI − 0.46, − 0.01, P=0.041) after adjustment, although the magnitude was smaller than that observed for some other variables.Conclusion: SVDD is independently associated with antibiotic burden in hospitalized COPD patients with exacerbation. Prospective studies are warranted to further explore this potential relationship and its clinical implications.Keywords: chronic obstructive pulmonary disease, exacerbation, hospitalization, 25-hydroxyvitamin D, severe deficiency, antibiotic use