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Post-surgery delirium in critically ill 1.4X more likely for each 10 ng lower level of vitamin D (below 30 ng) – July 2021

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

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VitaminDWiki pages containing DELIRIUM in title

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Vitamin D given before surgeries (prehabilitation) has greatly improved outcomes


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.

References

  • 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.


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