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
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- 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 540K IU 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
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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.
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