ICU patients with pneumonia stay 7 days longer if low vitamin D - Dec 2011

Originally published December 2010, Supplemental Critical Care Medicine Journal.

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Severe Vitamin D Deficiency Increases the Incidence, Length of Stay and Hospital Costs in Surgical Intensive Care Unit Patients with Ventilated-Associated Pneumonia

L. Ray Matthews, MD, Assistant Professor of Surgery, Morehouse School of Medicine,

Yusuf Ahmed, MD, MPH, Kenneth L. Wilson, MD, Assistant Professor of Surgery, Morehouse School of Medicine,

Diane D. Griggs, NP, Clinical Associate, Morehouse School of Medicine, Omar K.

Danner, MD, Assistant Professor of Surgery, Morehouse School of Medicine

ABSTRACT

Background:

Vitamin-D deficiency affects immune function in critically-ill patients. This study investigates the impact of vitamin-D deficiency in surgical intensive care unit (SICU) patients with ventilated-associated pneumonia (VAP).

Methods:

We performed a prospective assessment of the vitamin-D status on 191 patients admitted to the SICU between August 2009 and August 2010. Vitamin-D levels were measured by high pressure liquid chromatography (HPLC) and tandem mass spectrometry (Quest Lab). Vitamin D deficiency was defined as follows: severe <13; moderate 14-26; mild 27-39; and normal > 40 ng/ml.

Conclusion:

Severe vitamin-D deficiency increases VAP-incidence, LOS, and total hospital costs in SICU patients. Therefore, vitamin D deficiency should be corrected in critically-ill SICU patients expeditiously.

Background

Vitamin-D deficiency affects immune function in critically-ill patients. This study investigates the impact of vitamin-D deficiency in surgical intensive care unit (SICU) patients with ventilated-associated pneumonia (VAP).

Hypothesis

We hypothesize that severe vitamin-D deficiency increases the incidence, length of stay (LOS), hospital costs, and mortality rate in SICU patients with VAP.

Methods

We performed a prospective assessment of the vitamin-D status on 191 patients admitted to the SICU between August 2009 and August 2010. Vitamin-D levels were measured by high pressure liquid chromatography (HPLC) and tandem mass spectrometry (Quest Lab). Vitamin D deficiency was defined as follows: severe <13; moderate 14-26; mild 27-39; and normal > 40 ng/ml.

Results

Of the 191 patients, 129 (67.5%) were male, and 62 (32.5%) were female, 118 (61.8%) were African-Americans and 73 (38.2 %) were Caucasian. 62.3% were severe vitamin D deficiency, 29.3% moderate deficiency, and 6.8% mild deficiency. The incidence of VAP in the severe group was 30.3% versus 16 % in the non-severe (moderately & mildly deficiency) group (p value, 0.040). Mean LOS in the SICU for severely deficient group was 13.7 days versus 5.9 days. Average ICU cost was $68,862.52 for severe group with VAP versus $31,743.56 (p value, 0.001). Mortality rate for the severe vitamin D deficient group with VAP was 10.9% versus 5.6%, (p value, 0.220), a trend towards higher mortality.

	Severe Vit-D Deficient	Moder/Mild Vit-D	P_Value
	(N=119)	Deficient (N=72)
Male	60.5%	79.2%	0.008
Female	39.5%	20.8%
Black	72%	44.4%	0.000
White	27.0%	55.6%
Intubated	54.6%	25.0%	0.005
Pneumonia	30.0%	16.0%	0.04
Mortality	10.9%	5.6%	0.220
	Severe Vit-D Deficient	Moderate/Mild Vit-D Deficient
	Mean ± SEM	Mean ± SEM	P_Value
Age (Years)	47.13 ± 1.7	46.69± 2.1	NS
Vitamin_D Level(ng/ml)	8.04±0.28	21.83±0.97	0.000
Length of ICU Stay	13.73±0.94	5.88± 1.3	0.000
ICU Cost($)	$52,935.± 7,496.	$22,688.± 4,839.	0.000
VAP_ICU_Cost ($)	$68,862.±8,199.	$31,743.±5,345.	0.001

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See also VitaminDWiki

• Pneumonia patients 3 X more likely to die if low vitamin D – meta-analysis Sept 2017
• Pneumonia 2.6X more likely if low vitamin D – April 2013
• All items in Category After Surgery or Trauma and Vitamin D 352 items
• Search pneumoma in VitaminDWiki 270 items as of Oct 2013
• Being vitamin D deficient in the ICU is not good - Feb 2012 also by Dr. Matthews
• HMOs will save millions of dollars with vitamin D
• ICU time is 2X more likely to be longer than 2 days if vitamin D less than 20 ng – Mar 2011
• Critical Care patients with low vitamin D were 85 percent more likely to die – Sept 2011
• Critically ill 70 percent more likely to die if vitamin D less than 15 ng – Jan 2011
• ICU needs vitamin D - Vitamin D Council Sept 2011
• Critical Care patients need vitamin D
• Much more likely to die in ICU if vitamin D below 20 ng – Feb 2012
• ICU surgical patients with low vitamin D stayed longer and had more sepsis – Dec 2011
• Pneumonia is less frequent in people with more than 35 ng of vitamin D – Nov 2013