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Low vitamin D at ICU admission is associated with cancer, infections, acute respiratory insufficiency and liver failure – Oct 2018

Nutrition, online 24 October 2018, https://doi.org/10.1016/j.nut.2018.10.018

PDF is available free at Sci-Hub  10.1016/j.nut.2018.10.018

• 91.6% of ICU patients presented deficiency of serum 25(OH)vitamin D concentrations.
• 25(OH)vitamin D concentrations are strongly associated with prognostic indicators.
• 25(OH)vitamin D concentrations are strongly associated with clinical complications.

Background: Vitamin D deficiency may be associated with comorbidities and poorer prognosis. However, this association in intensive care unit (ICU) patients has not been fully elucidated.

Aim: To investigate whether the serum concentrations of 25-hydroxyvitamin D (25(OH)D) within the first 48 hours after ICU admission are associated with prognostic indicators (APACHE II, SOFA score, Charlson comorbidity index), clinical complications, serum C-reactive protein concentrations, mechanical ventilation duration, and mortality.

Methods: Seventy-one patients were admitted to the ICU, and their concentrations of 25(OH)D in the first 48 hours were analysed. To evaluate the prognostic factors in the ICU, the APACHE II, SOFA score, and Charlson comorbidity index (CCI) questionnaires as well as mechanical ventilation time, CRP and mortality were used.

Results: The mean concentration of 25(OH)D was 17.7 ± 8.27 (range 3.5–37.5) ng/mL, with 91.6% presenting with deficiency at admission. Although no associations were found between serum 25(OH)D concentrations with mechanical ventilation time, CRP, mortality, and APACHE II and SOFA severity scores, we found associations with the CCI when adjusted by age (Model 1: OR=1.64; 95%, 1.14–2.34) and by age, sex and body mass index (BMI) (Model 2: OR=1.59; 95%, 1.10–2.34). In addition, among the comorbidities present, 25(OH)D concentrations were inversely associated with cancer (Crude model OR=3.42; 95%, 1.21–9.64) and liver disease (Crude model OR=9.64; 95%, 2.28–40.60).

Conclusion: We found a strong association between 25(OH)D concentrations and the prognostic indicator CCI and clinical complications (acute respiratory insufficiency, acute liver failure and infections), but no associations with the prognostic indicators APACHE II and SOFA score, CRP, MV duration and mortality. The main comorbidities associated with low 25(OH)D were cancer and liver disease, suggesting that the determination of 25(OH)vitamin D is relevant during the ICU stay.

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