Preoperative Vitamin D Deficiency Is Associated With Postoperative Delirium in Critically Ill Patients
J Intensive Care Med . 2021 Jul 1;8850666211021330. doi: 10.1177/08850666211021330
Yuwei Qiu 1 2, Daniel I Sessler 1, Liang Chen 1 3, Sven Halvorson 1 3, Barak Cohen 1, Mauro Bravo 1, Ilker Ince 1 4, Kamal Maheshwari 1 5, Andrea Kurz 1 5
VitaminDWiki pages containing DELIRIUM in title
Trauma and surgery category starts with the followingTrauma and Surgery category has
see also Concussions
Overview Fractures and Falls and Vitamin D
Cancer - After diagnosis chemotherapy
TBI OR "Traumatic Brain Injury - 21 in title as of Sept 2022
Search VitaminDWiki for cathelecidin OR hCAP18 219 items as of March 2020
Search VitaminDWiki for ICU OR “critical care” OR “intensive care” OR “acute care”
1740 items as of May 2019
Search VitaminDWiki for transplant 794 items as of Jan 2018
Trauma and Surgery is associated with 22 other VitaminDWiki categories
Such as loading dose 33, Mortality 23, Infant-Child 21 Intervention 19 Cardiovascular 13, Injection 13 in Sept 2022
Vitamin D given before surgeries (prehabilitation) has greatly improved outcomes
- Improve your health BEFORE surgery (prehabilitation) helps your recovery - 2018
- Better Surgical outcomes if preceded by Vitamin D loading dose – Oct 2018
- Give Vitamin D before all spinal surgeries – no testing needed – June 2020
- Surgery outcome worse if low vitamin D (lumbar spine surgery this time) – Nov 2019
- Spinal Surgery patients – almost all have low vitamin D – Nov 2016
- Vitamin D needed after most spinal surgeries (and before as well) – 2013
- Half as many problems if take Vitamin D (300,000 IU) before thyroidectomy – RCT Jan 2021
- Vitamin D before surgery often helps (Thyroidectomy in this case) – Sept 2019
- Pre-operative Vitamin D often helps (thyroidectomy in this case) – June 2021
Introduction: Postoperative delirium is common, with a reported incidence of 11% to 80% in critically ill patients. Delirium is an independent prognostic factor for poor hospital outcomes. Low vitamin D concentrations are associated with a decline in cognitive function. We therefore tested the hypothesis that low preoperative serum 25-hydroxyvitamin D [25(OH)D] concentrations are associated with postoperative delirium in critically ill patients.
Method: We conducted a retrospective analysis of adults in a surgical intensive care unit for at least 48 hours immediately after non-cardiac and non-neurosurgical operations at Cleveland Clinic between 2013 and 2018. Delirium was assessed by trained nurses using CAM-ICU twice daily for the initial 5 postoperative days. Any positive value was considered evidence of delirium. We assessed the association between 25(OH)D concentrations within a year before surgery and the incidence of postoperative delirium using logistic regression, adjusted for potential confounders. A linear spline term with a knot at 30 ng/ml, the threshold for normal 25(OH)D concentration, was added to accommodate a nonlinear relationship between 25(OH)D concentrations and delirium.
Results: We included 632 patients, who had a mean (SD) 25(OH)D concentration of 25 (15) ng/ml; 55% (346/632) experienced delirium. We observed an adjusted odds ratio of 1.4 (95% CI: [1.1, 1.8], P = 0.01) for delirium per 10 ng/ml decrease in 25(OH)D concentrations when patients' 25(OH)D concentrations were less than 30 ng/ml. In patients whose 25(OH)D concentrations were at least 30 ng/ml, the adjusted odds ratio was 0.9 (95% CI: [0.7, 1.1], P = 0.36).
Conclusion: Preoperative 25(OH)D concentrations are associated with postoperative delirium in patients whose concentrations are below the normal threshold, but not at concentrations ≥30 ng/ml. A trial will be needed to determine whether the relationship is causal, and whether vitamin D supplementation before surgery might reduce the incidence of delirium.
- 1. Bryson, GL, Wyand, A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth. 2006;53(7):669–677.
- 2. Siddiqi, N, House, AO, Holmes, JD. Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing. 2006;35(4):350–364.
- 3. Ely, EW, Inouye, SK, Bernard, GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703–2710.
- 4. Devlin, JW, Brummel, NE, Al-Qadheeb, NS. Optimising the recognition of delirium in the intensive care unit. Best Pract Res Clin Anaesthesiol. 2012;26(3):385–393.
- 5. Leslie, DL, Marcantonio, ER, Zhang, Y, Leo-Summers, L, Inouye, SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32.
- 6. Lamond, E, Murray, S, Gibson, CE. Delirium screening in intensive care: a life saving opportunity. Intensive Crit Care Nurs. 2018;44:105–109.
- 7. Marcantonio, ER, Goldman, L, Mangione, CM, et al. A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994;271(2):134–139.
- 8. Robinson, TN, Raeburn, CD, Tran, ZV, et al. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249(1):173–178.
- 9. Zadshir, A TN, Pan, D, Norris, K, Martins, D. The prevalence of hypovitaminosis D among US adults: data from the NHANES III. Ethn Dis. 2005;15(4 suppl 5):S5–S97 -S101.
- 10. Balion, C, Griffith, LE, Strifler, L, et al. Vitamin D, cognition, and dementia: a systematic review and meta-analysis. Neurology. 2012;79(13):1397–1405.
- 11. Shen, L, Ji, HF. Vitamin D deficiency is associated with increased risk of Alzheimer’s disease and dementia: evidence from meta-analysis. Nutr J. 2015;14:76.
- 12. Lima, LAR, Lopes, MJP, Costa, RO, et al. Vitamin D protects dopaminergic neurons against neuroinflammation and oxidative stress in hemiparkinsonian rats. J Neuroinflammation. 2018;15(1):249.
- 13. Bourgeois, JA, Hategan, A, Ford, J, Tisi, DK, Xiong, GL. Delirium and hypovitaminosis D: neuroimaging findings. J Neuropsychiatry Clin Neurosci. 2015;27(1):69–71.
- 14. Ford, J, Hategan, A, Bourgeois, JA, Tisi, DK, Xiong, GL. Hypovitaminosis D in delirium: a retrospective cross-sectional study. Can Geriatr J. 2013;16(4):186–191.
- 15. Chen, H, Liu, Y, Huang, G, Zhu, J, Feng, W, He, J. Association between vitamin D status and cognitive impairment in acute ischemic stroke patients: a prospective cohort study. Clin Interv Aging. 2018;13:2503–2509.
- 16. Velayati, A, Vahdat Shariatpanahi, M, Dehghan, S, Zayeri, F, Vahdat Shariatpanahi, Z. Vitamin D and postoperative delirium after coronary artery bypass grafting: a prospective cohort study. J Cardiothorac Vasc Anesth. 2020;34(7):1774–1779.
- 17. Holick, MF, Binkley, NC, Bischoff-Ferrari, HA, et al. Endocrine Society . Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–1930.
- 18. Gusmao-Flores, D, Salluh, JIF, Chalhub, RÁ, Quarantini, LC. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies. Crit Care. 2012;16(4):R115.
- 19. Bowman, K, Jones, L, Pilling, LC, et al. Vitamin D levels and risk of delirium: a Mendelian randomization study in the UK Biobank. Neurology. 2019;92(12):e1387–e1394.
- 20. Sessler, CN, Gosnell, MS, Grap, MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–1344.
- 21. Morandi, A, Barnett, N, Miller, RR, et al. Vitamin D and delirium in critically ill patients: a preliminary investigation. J Crit Care. 2013;28(3):230–235.
- 22. Quraishi, SA, Litonjua, AA, Elias, KM, et al. Association between pre-hospital vitamin D status and hospital-acquired new-onset delirium. Br J Nutr. 2015;113(11):1753–1760.
- 23. Sankar, J, Lotha, W, Ismail, J, Anubhuti, C, Meena, RS, Sankar, MJ. Vitamin D deficiency and length of pediatric intensive care unit stay: a prospective observational study. Ann Intensive Care. 2016;6(1):3.
- 24. Ved, R, Taylor, P, Stewart, P, et al. Vitamin D deficiency is endemic in neurosurgical patients and is associated with a longer length of inpatient stay. Endocrinol Diabetes Metab. 2019;3(1):e00097.
- 25. Amrein, K, Schnedl, C, Holl, A, et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA. 2014;312(15):1520–1530.
- 26. Ginde, AA, Brower, RG, Caterino, JM, et al. Early high-dose vitamin D(3) for critically ill, vitamin D-deficient patients. N Engl J Med. 2019;381(26):2529–2540.
- 27. Holick, MF . The vitamin D deficiency pandemic: approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153–165.
- 28. Pittas, AG, Dawson-Hughes, B, Sheehan, P, et al. D2d Research Group . Vitamin D supplementation and prevention of type 2 diabetes. N Engl J Med. 2019;381(6):520–530.
- 29. Marcantonio, ER . Delirium in hospitalized older adults. N Engl J Med. 2017;377(15):1456–1466.
- 30. Pisani, MA, Kong, SY, Kasl, SV, et al. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092–1097.
|1980 visitors, last modified 01 Jul, 2021,