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To likely be similar across both the case and control population
Finally, it is possible that patients who initially had deficient vitamin D AZD8186 Purity & Documentation levels were recommended supplementation which may have increased their levels by the time of development of CA-CDI. This finding is clinical relevant to guide clinicians to routinely Bardoxolone methyl Description monitor vitamin D status in those at risk for C difficile.Competing interests The authors declare that they have no competing interests. Human studies of the role of vitamin D assessment in supplementation, particularly in those at high risk of C difficile.To likely be similar across both the case and control population and not result in a biased association. As in any observational study, there is the possibility for unmeasured confounders. We were able to adjust for most of the relevant variables including age, co-morbidity, antibiotic use and recent healthcare exposure. Additionally, this is a cross-sectional study, which does not allow for estimation of absolute risks or inference of causality. Finally, it is possible that patients who initially had deficient vitamin D levels were recommended supplementation which may have increased their levels by the time of development of CA-CDI. However, we believe this is unlikely to influence our findings for two reasons. Our results were robust on adjustment for supplemental vitamin D or multivitamin use, two commonly recommended methods for supplementing vitamin D levels. Second, such misclassification would actually bias our results towards the null making our effect sizes a more conservative estimate.Clinical relevancy statementClostridium difficile infection (CDI) is an important cause of morbidity and mortality. While commonly recognized as a hospital acquired infection, up to 40 of CDI could be acquired in the community by individuals with no extrinsic risk factors. Thus, identification of potential host factors that predispose to CDI is an important goal. In this study, we demonstrate low vitamin D to be associated with increased risk of CDI. Once confirmed in additional independent cohorts, this may form a basis for future clinical trials of vitamin D in the prevention and treatment of CDI. It may also help laboratory studies aiming to understand the host response to C difficile. This finding is clinical relevant to guide clinicians to routinely monitor vitamin D status in those at risk for C difficile.Competing interests The authors declare that they have no competing interests. Authors‘ contributions TS and AA developed study concept, reviewed data, conducted the statistical analysis, drafted the initial manuscript, revised and approved the final version. AA provided study supervision. Both authors read and approved the final manuscript. Financial conflicts of interests Dr. Ananthakrishnan has served on PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/26335592 title=View Abstract(s)">PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/28970286 the scientific advisory boards for Cubist pharmaceuticals and Abbvie. Acknowledgements The work was presented as an abstract at the American College of Gastroenterology Meeting, October 17?2; Philadelphia, PA. Sources of funding Dr. Ananthakrishnan is supported by a grant from the National Institutes of Health (DK097142). Author details 1 Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. 2Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA. 3MGH Crohn‘s and Colitis center, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA.
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