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Bed sores in ICU 2.5 X more likely if low vitamin D – Aug 2018

Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients.

Nutr Clin Pract. 2018 Aug 13. doi: 10.1002/ncp.10184. [Epub ahead of print]

PDF is available free at Sci-Hub  10.1002/ncp.10184
Otero TMN1,2,3, Canales C1,4, Yeh DD5,6, Elsayes A1,7, Belcher DM8, Quraishi SA1,9.
1 Dept of Anesthesia, Critical Care and Pain Medicine, Mass. General Hospital, Boston, Massachusetts.
2 School of Medicine, Tufts University, Boston, Massachusetts.
3 Department of Medicine, Carney Hospital, Boston, Massachusetts.
4 School of Medicine, University of California, Irvine, California.
5 Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
6 Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida.
7 Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts.
8 Dept of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts.
9 Harvard Medical School, Boston, Massachusetts.

BACKGROUND:
Hospital-acquired pressure injuries (HAPIs) typically develop following critical illness due to immobility and suboptimal perfusion. Vitamin D helps to maintain epithelial cell integrity, particularly at barrier sites such as skin. It is unclear whether vitamin D status is a modifiable risk factor for HAPIs in critically ill patients. Our goal was to investigate the relationship between admission 25-hydroxyvitamin D (25OHD) levels with the development of HAPIs in surgical intensive care unit (ICU) patients.

METHODS:
We performed a retrospective cohort study of patients admitted to surgical ICUs at a major teaching hospital in Boston, Massachusetts. To investigate the association of 25OHD levels with subsequent development of HAPIs, we performed logistic regression analyses, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU length of stay, and cumulative ICU caloric or protein deficit.

RESULTS:
A total of 402 patients comprised our analytic cohort. Each unit increment in 25OHD was associated with 11% decreased odds of HAPIs (odds ratio OR 0.89; 95% CI 0.840.95). When vitamin D status was dichotomized, patients with 25OHD <20 ng/mL were >2 times as likely to develop HAPIs (OR 2.51; 95% CI 1.065.97) compared with patients with 25OHD >20 ng/mL.

CONCLUSION:
In our cohort of critically ill surgical patients, vitamin D status at ICU admission was linked to subsequent development of HAPIs. Randomized, controlled trials are needed to assess whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPIs and improve other clinically relevant outcomes in critically ill patients.

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