Relationship of Vitamin D Deficiency to Clinical Outcomes in Critically Ill Patients

David M. Higgins, MS: University of Colorado School of Medicine, Aurora, Colorado
Paul E. Wischmeyer, MD paul.wischmeyer@ucdenver.edu : University of Colorado School of Medicine, Aurora, Colorado
Kelly M. Queensland, BA University of Colorado School of Medicine, Aurora, Colorado
Stefan H. Sillau, MS: University of Colorado, Aurora, Colorado
Alexandra J. Sufit, BA: University of Colorado School of Medicine, Aurora, Colorado
Daren K. Heyland, MD: Kingston General Hospital and Queen’s University, Kingston, Ontario, Canada
JPEN J Parenter Enteral Nutr April 20, 2012 0148607112444449
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Summary

196 ICU patients
84% had less than 24 nanograms of vitamin D when entering the ICU
Vitamin D levels dropped after 3 days in the ICU – and remained low for 10 days
ICU patients with higher level of vitamin D were 2X more likely to leave the ICU sooner
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Background: Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes.

Methods: The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes.

Results: Of analyzable patients, 50 (26%) were deficient (?30 nmol/L) and 109 (56%) were insufficient (>30 and ?60 nmol/L). Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001). 25(OH)D status was not significantly associated with 28-day all-cause mortality (hazard ratio HR, 0.89; 95% confidence interval, CI 0.37–2.24). Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge (HR, 2.11; 95% CI, 1.27–3.51). 25(OH)D-deficient patients showed a nonstatistically significant trend toward a higher infection rate (odds ratio OR, 3.20; 95% CI, 0.784–13.07; P = .11) compared with patients with sufficient levels of 25(OH)D.

Conclusions: This study demonstrates significant decreases in vitamin D status over the duration of the patient’s ICU stay. Low levels of vitamin D are associated with longer time to ICU discharge alive and a trend toward increased risk of ICU-acquired infection. (JPEN J Parenter Enteral Nutr. XXXX;xx:xx-xx)

PMID: 22523178
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See also VitaminDWiki

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• Critical Care patients with low vitamin D were 85 percent more likely to die – Sept 2011
• Critically ill 70 percent more likely to die if vitamin D less than 15 ng – Jan 2011
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• Much more likely to die in ICU if vitamin D below 20 ng – Feb 2012
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