Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa
Endocrine Connections, DOI: https://doi.org/10.1530/EC-18-0184
Karin Amrein 1 , Alja Papinutti 2 , Erwin Mathew 3 , Greisa Vila greisa.vila@meduniwien.ac.at 4 and Dhruv Parekh 5
- PDF has tables describing many complete and on-going trials
- One big trial using 540,000 IU loading doses is not due to be completed until 2022 - and probably not reported until 2024
- VitaminDWiki suspects that >10,000 people with critical illnesses will die while we wait for the research to be absolutely, positively sure that loading doses help critical illnesses
Trauma and surgery category starts with the following
Trauma and Surgery category hasLarge dose Vitamin D before surgery was found to help by 35 studies
Vitamin D is needed before most surgeries – many studies and RCTs
4.8 X more likely to die within 28 days of ICU if low Vitamin D - Jan 2024
Sepsis is both prevented and treated by Vitamin D - many studies
Thyroidectomy and Vitamin D - many studies
Orthopaedic surgeries need Vitamin D – many studies
Cancer - After diagnosis chemotherapy
TBI OR "Traumatic Brain Injury - 21 in title as of Sept 2022
Superbug (Clostridium difficile) Infections strongly associated with low vitamin D - many studies
Glutamine and Omega-3 have also been proven to help several traumas/surgeries
Note: Vitamin D also prevents the need for various surgeries and Omega-3 prevents many concussions/TBI
Trauma and Surgery is associated with 22 other VitaminDWiki categories
Such as loading dose 33, Mortality 23, Infant-Child 21 Intervention 19 Cardiovascular 13, Injection 13 in Sept 2022
Download the PDF from VitaminDWiki
The prevalence of vitamin D deficiency in intensive care units ranges typically between 40 and 70 %. There are many reasons for being or becoming deficient in the ICU. Hepatic, parathyroid and renal dysfunction aditionally increase the risk for developing vitamin D deficiency. Moreover, therapeutic interventions like fluid resuscitation, dialysis, surgery, extracorporeal membrane oxygenation, cardiopulmonary bypass and plasma exchange may significantly reduce vitamin D levels.
Many observational studies have consistently shown an association between low vitamin D levels and poor clinical outcomes in critically ill adults and children, including excess mortality and morbidity such as acute kidney injury, acute respiratory failure, duration of mechanical ventilation and sepsis.
It is biologically plausible that vitamin D deficiency is an important and modifiable contributor to poor prognosis during and after critical illness.
Although vitamin D supplementation is inexpensive, simple and has an excellent safety profile, testing for and treating vitamin D deficiency is currently not routinely performed. Overall, less than 800 patients have been included in RCTs worldwide, but the available data suggest that high-dose vitamin D supplementation could be beneficial. Two large RCTs in Europe and the US, together aiming to recruit > 5000 patients, have started in 2017, and will greatly improve our knowledge in this field. This review aims to summarize current knowledge in this interdisciplinary topic and give an outlook on its highly dynamic future.
Conclusion (from the PDF)
Over the last decade, experimental, observational and clinical studies have
highlighted the high prevalence of vitamin D deficiency, and its strong association
with morbidity and mortality in critical illness. The scientific rationale as to why this
may be the case is compelling. Supporters of vitamin D do not suggest it to be the
panacea but this hormone plays an important pleiotropic role in the setting of critical
illness and may support recovery from severe acute illness. We now have a better,
albeit not complete understanding from clinical trials of the potential target vitamin D
level and dosing strategies required for conferring benefit. Importantly, vitamin D
testing and supplementation is readily available, safe, and inexpensive and could be
rapidly implemented into clinical practice if the on-going trials show benefit.
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