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Low Vitamin D when entering ICU is deadly (acute kidney injury in this case) – Aug 2017

Med Intensiva. 2017 Aug 25. pii: S0210-5691(17)30217-6. doi: 10.1016/j.medin.2017.07.004. [Epub ahead of print], [Article in English, Spanish]

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Zapatero A1, Dot I2, Diaz Y2, Gracia MP3, Pérez-Terán P2, Climent C2, Masclans JR4, Nolla J4.

  • 1 Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: 96022 at hospitaldelmar.cat.
  • 2 Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España.
  • 3 Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.
  • 4 Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, España; Grupo de Investigación en Patología Crítica (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Pompeu Fabra, Barcelona, España.


OBJECTIVES: To evaluate the prevalence of vitamin D deficiency in critically ill patients upon admission to an Intensive Care Unit (ICU) and its prognostic implications.

DESIGN: A single-center, prospective observational study was carried out from January to November 2015. Patients were followed-up on until death or hospital discharge.

SETTING: The department of Critical Care Medicine of a university hospital.

PATIENTS: All adults admitted to the ICU during the study period, without known factors capable of altering serum 25(OH)D concentration.

INTERVENTIONS: Determination of serum 25(OH)D levels within the first 24h following admission to the ICU.

MAIN VARIABLES OF INTEREST: Prevalence and mortality at 28 days.

RESULTS:
The study included 135 patients, of which 74% presented deficient serum 25(OH)D levels upon admission to the ICU. Non-survivors showed significantly lower levels than survivors (8.14ng/ml [6.17-11.53] vs. 12ng/ml [7.1-20.30]; P=.04], and the serum 25(OH)D levels were independently associated to mortality (OR 2.86; 95% CI 1.05-7.86; P=.04]. The area under the ROC curve was 0.61 (95% CI 0.51-0.75), and the best cut-off point for predicting mortality was 10.9ng/ml. Patients with serum 25(OH)D<10.9ng/ml also showed higher acute kidney injury rates (13 vs. 29%; P=.02).

CONCLUSION:
Vitamin D deficiency is highly prevalent upon admission to the ICU. Severe Vitamin D deficiency (25[OH]D<10.9ng/ml) upon admission to the ICU is associated to acute kidney injury and mortality.

PMID: 28847615 DOI: 10.1016/j.medin.2017.07.004 PDF is behind a publisher paywall


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