Admission vitamin D status is associated with discharge destination in critically ill surgical patients
Annals of Intensive Care (2015) 5:23 DOI 10.1186/s13613-015-0065-9
Karolina Brook , Carlos A. Camargo2,3,4, Kenneth B. Christopher3,5 and Sadeq A. Quraishi squraishi at mgh.harvard.edu
|< 20 ng||> 20 ng|
|Die in hospital||20%||9%|
|Discharge to home||28%||66%|
See also VitaminDWiki
- Surgical outcomes are better for higher levels of Vitamin D – systematic review May 2015
- 3X more likely to die within 3 months of being in ICU for 2 days if less than 20 ng vitamin D – Sept 2013
- Risk of death within 90 days of ICU decreased by 16 percent for 1 nanogram extra vitamin D – June 2014
- ICU death 2X more likely if low vitamin D (sensitivity and selectivity chart) – May 2015
- ICU patients with low Magnesium were 2X more likely to die – June 2014
- ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014
- Search VitaminDWiki for ICU OR “critical care” OR “intensive care” OR “acute care”
459 items as of June 2015
Background: Discharge destination after critical illness is increasingly recognized as a valuable patient-centered outcome. Recently, vitamin D status has been shown to be associated with important outcomes such as length of stay (LOS) and mortality in intensive care unit (ICU) patients. Our goal was to investigate whether vitamin D status on ICU admission is associated with discharge destination.
Methods: We performed a retrospective analysis from an ongoing prospective cohort study of vitamin D status in critical illness. Patients were recruited from two surgical ICUs at a single teaching hospital in Boston, Massachusetts.
All patients had 25-hydroxyvitamin D (25OHD) levels measured within 24 h of ICU admission. Discharge destination was dichotomized as non-home or home. Locally weighted scatterplot smoothing (LOWESS) was used to graph the relationship between 25OHD levels and discharge destination. To investigate the association between 25OHD level and discharge destination, we performed logistic regression analyses, controlling for age, sex, race, body mass index, socioeconomic status, acute physiology and chronic health evaluation II score, need for emergent vs. non-emergent surgery, vitamin D supplementation status, and hospital LOS.
Results: 300 patients comprised the analytic cohort. Mean 25OHD level was 19 (standard deviation 8) ng/mL and 41 % of patients had a non-home discharge destination. LOWESS analysis demonstrated a near-inverse linear relationship between vitamin D status and non-home discharge destination to 25OHD levels around 10 ng/mL, with rapid flattening of the curve between levels of 10 and 20 ng/mL. Overall, 25OHD level at the outset of critical illness was inversely associated with non-home discharge destination (adjusted OR, 0.88; 95 % CI 0.82-0.95). When vitamin D status was dichotomized, patients with 25OHD levels <20 ng/mL had an almost 3-fold risk of a non-home discharge destination (adjusted OR, 2.74; 95 % CI 1.23-6.14) compared to patients with 25OHD levels >20 ng/mL.
Conclusions: Our results suggest that vitamin D status may be a modifiable risk factor for non-home discharge destination in surgical ICU patients. Future randomized, controlled trials are needed to determine whether vitamin D supplementation in surgical ICU patients can improve clinical outcomes such as the successful rate of discharge to home after critical illness