A Multicenter Study Analyzing the Association of Vitamin D Deficiency and Replacement with Infectious Outcomes in Patients with Burn Injuries
Burns https://doi.org/10.1016/j.burns.2021.10.020
Katelyn M.Garner a Sarah Zaval ab Kate O Pape cTodd Walroth d Melissa Reger e WendyThomasf Brittany Hoy tef Beatrice Adams g David M.Hill a
Highlights
- More than half of patients with thermal injuries have vitamin D deficiency on admission
- Patients with larger burns have a higher risk for vitamin D deficiency
- Vitamin D deficiency increases risk for infection and use of vasopressors
- Patients with vitamin D deficiency required more days of extracorporeal support
- Delaying vitamin D supplementation increases risk for infection
Vitamin D (25OHD) deficiency has been associated with poor outcomes in intensive care populations. The primary objective of this 7-center study was to determine if 25OHD deficiency is associated with infectious outcomes in adult burn patients. Generalized linear mixed modelling was used to control for center effect, percent total body surface area burn (% TBSA), age, and presence of inhalation injury. A total of 1147 patients were initially included (admitted January 2016 through August 2019). After exclusions, 234 (56.8%) in the deficient (25OHD < 20 ng/mL) and 178 in the non-deficient group (25OHD ≥ 20 ng/mL) remained, surpassing a priori power requirements. The non-deficient group had their concentration drawn earlier (p < 0.001), were more likely to be male (p = 0.006), Caucasian (p < 0.001), have lower body mass index (p = 0.009), lower % TBSA (p = 0.002), and taking a 25OHD supplement prior to admission (p < 0.001). Deficient patients were more likely to have an infectious outcome (52.1% vs 36.0%, p = 0.002), acute kidney injury requiring renal replacement therapy (p = 0.009), less ventilator free days in the first 28 days (p < 0.001), and vasopressors (p = 0.01). After controlling for center, % TBSA, age, and inhalation injury the best model also included
- presence of deficiency (OR 2.425 [CI 1.035 - 1.252]),
- days until 25OHD supplement initiation (OR 1.139 [CI 1.035 - 1.252]), and
- choice of cholecalciferol over ergocalciferol (OR 2.112 [CI 1.151 - 3.877]).
To the authors' knowledge, this is the first multicenter study to evaluate the relationship between 25OHD and infectious complications in burn patients.