20 percent of Critically ill in India had undetectable vitamin D, and 62 percent died – Jan 2013

Vitamin D Deficiency in Critical Illness and Its Influence on Outcome: Experience From Tertiary Care Centre in North India

Critical Care Medicine: doi: 10.1097/01.ccm.0000424989.62300.45, Oral Abstract Session: ABSTRACT Only, 774:
Azim, Afzal; Ahmed, Armeen; Baronia, Arvind; Yadav, Subhash

Introduction: Vitamin D deficiency can range from 50% to 90% in select general population and has been associated with increased mortality.
Limited studies are available on vitamin D deficiency in critically ill population.
Pleiotropic actions of vitamin D may contribute to mortality and morbidity in critically ill patients.

Hypothesis: To analyze severity of vitamin D deficiency in critically ill Indian population and its possible association with outcome.

Methods: 160 critically ill patients were prospectively enrolled over two years.158 patients were analyzed. Exclusion criteria included age < than 18 years, pregnancy, patients on corticosteroids, patients with malabsorption syndrome, chronic kidney disease & patients on drugs interfering with vitamin D metabolism. Demographic profile & clinical characteristics were noted at enrollment. Blood sample for serum 25 (OH) D was collected at admission (04 ml).Serum 25 (OH) D was measured using Radio Immuno Assay kit. Vitamin D deficiency was labeled as insufficient (31-60 nmol/lt), deficient (15-30nmol/lt) and (< 15 nmol/lt).Clinical management was done as per the treating team. Statistical tests used were t-test, Chi-square test & Binary logistic regression.

Results: Vitamin D deficiency (< 60nmol/lt) was present in 127 patients (80.4%). 53 patients (41.73%) were insufficient, 48 patients (37.79%) were deficient and 26 patients had (20.47%) undetectable Vit D levels. Mean Vitamin D level was higher amongst survivors (43.17+39.22) than non-survivors (39.72+ 29.31) though the difference was not statistically significant (p=0.53). Out of 26 patients in undetectable levels 16 patients died (61.53%). All the study variables were considered and best model with 90.5% overall correct classification was found with SOFA, APACHE II, Vitamin D levels and days of Mechanical ventilation. On multivariate analysis Vitamin D level had an OR of 1.015 as compared to APACHE II (OR=0.908) and SOFA (OR=0.891).

Conclusions: Vitamin D deficiency is common in critically ill patients. Further research is needed whether its deficiency can be an independent predictor of outcome and should we routinely supplement Vitamin D in all patients requiring ICU admission.

(C) 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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See also VitaminDWiki

• Why India's vitamin D deficiency is grim - 40 pages Feb 2014
• Critically ill 70 percent more likely to die if vitamin D less than 15ng – Jan 2011
• Critical Care patients 85 percent more likely to die if less than 20 ng vitamin D - Jan 2012
• Critical Care patients with less than 15 ng vitamin D were 85 percent more likely to die – Sept 2011
• Almost 6X more likely to die after coronary bypass if vitamin D deficient – Dec 2012
• Plasma exchange cut vitamin D levels in half – June 2012
• Only 200 IU vitamin D in intravenous feeding of multivitamins – Aug 2012 another case where hospitals are not aware of the need for vitamin D
• Being vitamin D deficient in the ICU is not good - Feb 2012
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