Neither Vitamin D Levels Nor Supplementation Are Associated with Persistent Critical Illness: A Retrospective Cohort Analysis
B22 CRITICAL ILLNESS MANAGEMENT AND OUTCOMES – Poster Discussion Session . Monday, May 2 2019
E.M. Viglianti 4, P. Zajic 1 T.J. Iwashyna 3, K. Amrein 2,
E. M. Viglianti1, P. Zajic2, T. J. Iwashyna3, K. Amrein4; 'Pulmonary Critical Care, University of Michigan, Ann Arbor, Ml, United States, Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria, internal Medicine. Division of Pulmonary Critical Care, Univof Michigan, Ann Arbor, Ml, United States, internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
Low Vitamin D for both those <10 days and >10 days - across all reasons for being in ICU
Abstract does not mention how much vitamin D was added
- suspect very small doses as the data is from 2009
- Heart attack ICU costs cut in half by Vitamin D – Oct 2018
- 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016
- Heart Attack ICU costs reduced $37,000 by $20 of Vitamin D – Nov 2015
- ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014
- Vitamin D intervention increased by 20 percent the survival of critically ill patients- RCT June 2014
- Increased Hospital, Sepsis deaths if low vitamin D – March 2014
- ICU patients 30 percent less likely to die if have enough vitamin D – meta-analysis Nov 2016
- Vitamin D appears essential to survive many critical illnesses - review Oct 2018
Background: Low levels of vitamin D are associated with poor outcomes among critically ill patients, thought to be mediated via vitamin D's pleiotropic effects on the immune system. The relationship between vitamin D and the development of persistent critical illness (ICU stay >10 days) is unknown. The purpose of this study was to develop hypotheses about whether lower levels of vitamin D are associated with increased rates of persistent critical illness, and whether repletion of vitamin D among those with low levels leads to decreased persistent critical illness.
Methods: We conducted a secondary analysis of
- (a) a cohort of patients admitted to the University Medical Center Graz, Austria, who were admitted to seven medical and surgical ICUs from July 2008 - April 2010, to evaluate the association between vitamin D and the development of persistent critical illness; and
- (b) the cohort from the VlTdAL-tCU randomized clinical trial, to understand the impact of vitamin D3 supplementation on the development of persistent critical illness in patients with vitamin D deficiency.
Results: In the retrospective cohort of 655 people, 628 were included in the analysis of whom 28,8% (n = 181) developed persistent critical illness, The mean 25-hydroxy vitamin D level was 17.4 ng/mL (IQR 11.2,25.2), Among patients admitted to the ICU, vitamin D3 level on admission was not significantly associated with the development of persistent critical illness compared to those discharged alive earlier (RRR: 1.02,95% Cl: 1,00 - 1.04) or who died (RRR: 1.02,95%Cl: 0,99 -1,05). In the ViTdAL-ICU randomized trial,the mean 25-hydroxivttamin D level was 13.1 ng/mL (SD: 4.3) and 13.0 ng/mL (SD: 4.0) in the placebo and treatment groups respectively. In the 475 patients, 46,7% (n = 222) developed persistent critical illness.
Supplementation with vitamin D3 did not lead to less persistent illness relative to those discharged alive before the onset of persistent critical illness (RRR: 1.19, 95% Cl 0,76 -1.80) or those who died before the onset of persistent critical illness (RRR: 1.34,95% Cl 0.72 - 2.52).
Conclusion: Vitamin D3 deficiency was not associated with persistent critical illness, nor did supplementation with vitamin D3 mitigate the development of persistent critical illness.