Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients
J Intensive Care Med . 2021 Jul 1;8850666211021330. doi: 10.1177/08850666211021330
Yuwei Qiu 1 2, Daniel I Sessler 1, Liang Chen 1 3, Sven Halvorson 1 3, Barak Cohen 1, Mauro Bravo 1, Ilker Ince 1 4, Kamal Maheshwari 1 5, Andrea Kurz 1 5
Trauma and surgery category starts with the followingTrauma and Surgery category has
see also Concussions
Overview Fractures and Falls and Vitamin D
Cancer - After diagnosis chemotherapy
TBI OR "Traumatic Brain Injury - 21 in title as of Sept 2022
Search VitaminDWiki for cathelecidin OR hCAP18 219 items as of March 2020
Search VitaminDWiki for ICU OR “critical care” OR “intensive care” OR “acute care”
1740 items as of May 2019
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Trauma and Surgery is associated with 22 other VitaminDWiki categories
Such as loading dose 33, Mortality 23, Infant-Child 21 Intervention 19 Cardiovascular 13, Injection 13 in Sept 2022
- Off topic: Improving your health BEFORE surgery (prehabilitation) helps your recovery - 2018
- Better Surgical outcomes if preceded by Vitamin D loading dose – Oct 2018
- Give Vitamin D before all spinal surgeries – no testing needed – June 2020
- Surgery outcome worse if low vitamin D (lumbar spine surgery this time) – Nov 2019
- Spinal Surgery patients – almost all have low vitamin D – Nov 2016
- Vitamin D needed after most spinal surgeries (and before as well) – 2013
- Half as many problems if take Vitamin D (300,000 IU) before thyroid surgery – RCT Jan 2021
- Vitamin D before surgery often helps (Thyroidectomy in this case) – Sept 2019
- Pre-operative Vitamin D often helps (thyroidectomy in this case) – June 2021
Introduction: Postoperative delirium is common, with a reported incidence of 11% to 80% in critically ill patients. Delirium is an independent prognostic factor for poor hospital outcomes. Low vitamin D concentrations are associated with a decline in cognitive function. We therefore tested the hypothesis that low preoperative serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with postoperative delirium in critically ill patients.
Method: We conducted a retrospective analysis of adults in a surgical intensive care unit for at least 48 hours immediately after non-cardiac and non-neurosurgical operations at Cleveland Clinic between 2013 and 2018. Delirium was assessed by trained nurses using CAM-ICU twice daily for the initial 5 postoperative days. Any positive value was considered evidence of delirium. We assessed the association between 25(OH)D concentrations within a year before surgery and the incidence of postoperative delirium using logistic regression, adjusted for potential confounders. A linear spline term with a knot at 30 ng/ml, the threshold for normal 25(OH)D concentration, was added to accommodate a nonlinear relationship between 25(OH)D concentrations and delirium.
Results: We included 632 patients, who had a mean (SD) 25(OH)D concentration of 25 (15) ng/ml; 55% (346/632) experienced delirium. We observed an adjusted odds ratio of 1.4 (95% CI: [1.1, 1.8], P = 0.01) for delirium per 10 ng/ml decrease in 25(OH)D concentrations when patients' 25(OH)D concentrations were less than 30 ng/ml. In patients whose 25(OH)D concentrations were at least 30 ng/ml, the adjusted odds ratio was 0.9 (95% CI: [0.7, 1.1], P = 0.36).
Conclusion: Preoperative 25(OH)D concentrations are associated with postoperative delirium in patients whose concentrations are below the normal threshold, but not at concentrations ≥30 ng/ml. A trial will be needed to determine whether the relationship is causal, and whether vitamin D supplementation before surgery might reduce the incidence of delirium.
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