Aggressive Treatment of Vitamin D Deficiency in Hispanic and African American Critically Injured Trauma Patients Reduces Health Care Disparities (Length of stay, Costs, and Mortality) in a Level I Trauma Center Surgical Intensive Care Unit
Global Journal of Medical and Clinical Case Reports, 4(2): 042-046. DOI: http://doi.org/10.17352/2455-5282.000044, Published: 27 April, 2017
316 dark skinned ICU patients were treated with Vitamin D
70% blunt trauma, 30% penetrating trauma
|Treatment||Vit D||Length |
not statis. significant
|50,000 IU weekly for up to 8 weeks, |
orally or nasogastric tube first week = 50,000 IU
|10 ng||13 days||$51,000||11%|
|50,000 IU daily for 5 days first week = 250,000 IU||14 ng||12 days||$44,000||9%|
|50,000 IU daily down the nasogastric tube for 7 consecutive days first week = 350,000 IU||16 ng||6 days||$24,000||6%|
- ICU cost reduced by at least 27,000 dollars if get high dose vitamin D in first week - April 2017
- Hospital ICU added high dose vitamin D - malpractice lawsuit costs dropped from 26 million dollars to ZERO - Oct 2016
- 18 fewer hospital days if given 500,000 IU of vitamin D while ventilated in ICU – RCT June 2016
- ICU survival increased with vitamin D single loading dose - JAMA Sept 2014
- ICU patients 30 percent less likely to die if have enough vitamin D – meta-analysis Nov 2016
- Risk of death within 90 days of ICU decreased by 16 percent for 1 nanogram extra vitamin D – June 2014
- Mild Traumatic Brain Injury reduced by Vitamin D – May 2014
- US Army learning about benefits of vitamin D to trauma – Dec 2013
- Overview Dark Skin and Vitamin D
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
Search VitaminDWiki for TBI OR "Traumatic Brain Injury" 798 items as of March 2020
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
L Ray Matthews 1*, Yusuf Ahmed 2, Omar Danner 1, Michael Williams 1, Carl Lokko 1, Jonathan Nguyen 1, Keren Bashan-Gilzenrat 1, Diane Dennis-Griggs 1, Nekelisha Prayor 1, Peter Rhee 4, Ed W Childs 1, Kenneth Wilson 3 and William B Grant 5
1 Morehouse School of Medicine, Atlanta, GA, USA 2 Sidra Medical and Research Center, Doha, Saudi Arabia, 3 Michigan State University College of Human Medicine, East Lansing, MI, USA 4 Grady Memorial Hospital, Atlanta, GA, USA 5 Sunlight, Nutrition and Health Research Center (SUNARC) San Francisco, CA, USA
*Corresponding author: L Ray Matthews, Associate Professor of Surgery, Morehouse School of Medicine, Department of Surgery, 720 Westview Drive, SW, Atlanta, GA 30310, Tel: (404) 616-2391 E-mail: lematthews at msm.edu; rmatt63 at yahoo.com
Background: Socioeconomics only account for 18% of all healthcare disparities. Healthcare disparities in the intensive care unit (ICU) have been well documented and persist in spite of previous government and medical interventions. Vitamin D deficiency is the most common nutritional deficiency in the United States and the world. This deficiency has been largely overlooked in the debate on healthcare disparities.
Hypothesis: We hypothesize that low vitamin D levels (a steroid hormone that activates CD4, a T-cell for immune response) and a low CD4 cell count (a T-cell and a marker of a weak immune system) account for most of these healthcare disparities seen in Hispanic and African American patients. We further hypothesize that aggressive treatment of vitamin D deficiency decreases intensive care unit (ICU) length of stay (LOS), ICU cost, and mortality rate in this patient population.
Methods: We performed a prospective study of the vitamin D status on 316 Hispanic and African American patients admitted to Grady Hospital SICU from August 2009 to September 2011. The patients were divided into 3 groups:
- Group 1 was treated with vitamin D 50,000 international units (IU) weekly, orally
or nasogastric tube (50,000-400,000 IU) for up to 8 weeks;
- Group 2 was treated with vitamin D 50,000 IU daily for 5 days (250,000 IU of vitamin D); and
- Group 3 patients (aggressive treatment) received vitamin D 50,000 IU daily down the nasogastric tube for 7 consecutive days.
The injury severity score (ISS) was a mean of approximately 15 in all three groups. There wasn't any statistical difference between the three groups in terms of injury severity. A CD4 cell count was measured in a subset of 180 patients to evaluate as a marker for potential immune system compromise or weak immune system. In our surgical intensive care unit, Hispanic and African American patients had lower vitamin D levels and CD4 counts up to 40% lower than Caucasian Americans.
Results: The mean vitamin D levels for the three groups were as follows:
- Group 1, 10.22 ±0.60 ng/ ml;
- Group 2, 13.78 ±0.72 ng/ml; and
- Group 3, 15.89 ±0.87 ng/ml (normals 40 ng/ml).
Mean ICU LOS decreased with aggressive treatment of vitamin D deficiency from
- 13.21 ±2.04 days in Group 1 to
- 11.53 ±2.45 days in Group 2 to
- 6.3 ±0.79 days in Group 3 (p-value, 0.01').
Mean ICU cost also decreased with aggressive treatment of vitamin D deficiency by the following:
- Group 1, $50,934.25 ±7, 8776;
- Group 2, $44,464.50 ±9,458.50; and
- Group 3, $24,433.02 ±2,887.75 (p-value, 0.021).
Mortality rate decreased from
- 11.0% in Group 1 to
- 9.4% in Group 2 to
- 6.4% in Group 3 (p-value, 0.486).
This trend shows a clinically significant 42% reduction in mortality rate which is clinically significant even though it is not statistically significant.
Conclusion: We conclude that a compromised immune state due to low vitamin D status and low CD4 cell count may explain a large percentage of healthcare disparities. Aggressively optimizing serum vitamin D status to > 40 ng/ml may be the one of the most important steps in solving healthcare disparities in the United States. Further studies on low vitamin D levels/low CD4 counts are needed to fully address healthcare disparities.