Admission vitamin D status is associated with discharge destination in critically ill surgical patients

Acute Respiratory Distress Syndrome; A Review of Recent Updates and a Glance into the Future

Acute respiratory distress syndrome (ARDS) is a rapidly progressive form of respiratory failure that accounts for 10% of admissions to the ICU and is associated with approximately 40% mortality in severe cases. Despite significant mortality and healthcare burden, the mainstay of management remains supportive care. The recent pandemic of SARS-CoV-2 has re-ignited a worldwide interest in exploring the pathophysiology of ARDS, looking for innovative ideas to treat this disease. Recently, many trials have been published utilizing different pharmacotherapy targets; however, the long-term benefits of these agents remain unknown. Metabolomics profiling and stem cell transplantation offer strong enthusiasm and may completely change the outlook of ARDS management in the near future.

A Machine Learning Based Discharge Prediction of Cardiovascular Diseases Patients in Intensive Care Units

This paper targets a major challenge of how to effectively allocate medical resources in intensive care units (ICUs). We trained multiple regression models using the Medical Information Mart for Intensive Care III (MIMIC III) database recorded in the period between 2001 and 2012. The training and validation dataset included pneumonia, sepsis, congestive heart failure, hypotension, chest pain, coronary artery disease, fever, respiratory failure, acute coronary syndrome, shortness of breath, seizure and transient ischemic attack, and aortic stenosis patients’ recorded data. Then we tested the models on the unseen data of patients diagnosed with coronary artery disease, congestive heart failure or acute coronary syndrome. We included the admission characteristics, clinical prescriptions, physiological measurements, and discharge characteristics of those patients. We assessed the models’ performance using mean residuals and running times as metrics. We ran multiple experiments to study the data partition’s impact on the learning phase. The total running time of our best-evaluated model is 123,450.9 mS. The best model gives an average accuracy of 98%, highlighting the location of discharge, initial diagnosis, location of admission, drug therapy, length of stay and internal transfers as the most influencing patterns to decide a patient’s readiness for discharge.

Prevalence of Vitamin D Deficiency and Associated Factors in Critically Ill Patients: A Multicenter Observational Study

Background: Vitamin D deficiency is common in the general population worldwide, and the prevalence and severity of vitamin D deficiency increase in critically ill patients. The prevalence of vitamin D deficiency in a community-based cohort in Northern Taiwan was 22.4%. This multicenter cohort study investigated the prevalence of vitamin D deficiency and associated factors in critically ill patients in Northern Taiwan. Methods: Critically ill patients were enrolled and divided into five groups according to their length of stay at intensive care units (ICUs) during enrolment as follows: group 1, <2 days with expected short ICU stay; group 2, <2 days with expected long ICU stay; group 3, 3-7 days; group 4, 8-14 days; and group 5, 15-28 days. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25(OH)D) level < 20 ng/ml, and severe vitamin D deficiency was defined as a 25(OH)D level < 12 ng/ml. The primary analysis was the prevalence of vitamin D deficiency. The exploratory analyses were serial follow-up vitamin D levels in group 2, associated factors for vitamin D deficiency, and the effect of vitamin D deficiency on clinical outcomes in critically ill patients. Results: The prevalence of vitamin D deficiency was 59% [95% confidence interval (CI) 55-62%], and the prevalence of severe vitamin D deficiency was 18% (95% CI 15-21%). The median vitamin D level for all enrolled critically ill patients was 18.3 (13.7-23.9) ng/ml. In group 2, the median vitamin D levels were <20 ng/ml during the serial follow-up. According to the multivariable analysis, young age, female gender, low albumin level, high parathyroid hormone (PTH) level, and high sequential organ failure assessment (SOFA) score were significantly associated risk factors for vitamin D deficiency. Patients with vitamin D deficiency had longer ventilator use duration and length of ICU stay. However, the 28- and 90-day mortality rate were not associated with vitamin D deficiency. Conclusions: This study demonstrated that the prevalence of vitamin D deficiency is high in critically ill patients. Age, gender, albumin level, PTH level, and SOFA score were significantly associated with vitamin D deficiency in these patients.

Association of vitamin D deficiency with clinical presentation of COVID-19

Background

The coronavirus disease 2019 (COVID-19) is a respiratory virus, the spread of which has caused a global pandemic with catastrophic consequences. The current study aimed to investigate the association between vitamin D deficiency and the clinical presentation of COVID-19.

Patients and methods

The current study included 166 COVID-19 patients recruited from Prince Mohammad Bin Abdulaziz Hospital in Riyadh, Saudi Arabia. The study was conducted from October 2020 to January 2021. Patients were diagnosed by positive polymerase chain reaction (PCR) results. History and clinical data were collected for all subjects. In addition, laboratory analysis was done to estimate blood levels of 25 hydroxyvitamin D (25(OH)D), C-reactive protein (CRP), ferritin, parathyroid hormone (PTH), alanine aminotransferase (ALT), D-dimer, calcium, and relative lymphocytic count. COVID-19 patients were divided into three subgroups according to their vitamin D status. Patients were considered sufficient when their vitamin D level was above 30 ng/mL. Patients with vitamin D levels below 20 ng/mL were considered deficient. Patients with vitamin D levels ranging from 20 ng/mL to 30 ng/mL were considered insufficient.

Results

Our results showed that 81 patients (49%) were deficient in vitamin D, and 48 patients (29%) were insufficient in vitamin D. Only 37 patients (22%) had normal vitamin D levels. Moreover, a significant difference was found regarding the inflammatory markers of COVID-19 severity. Also, vitamin D levels were inversely correlated with the markers used for monitoring the condition of COVID-19 patients: ferritin, CRP, and D-dimer.

Conclusion

Our results showed that vitamin D deficiency was associated with increased levels of inflammatory markers of COVID-19 infection.

Vitamin D Status and Clinical Outcomes in Acute Respiratory Distress Syndrome: A Secondary Analysis From the Assessment of Low Tidal Volume and Elevated End-Expiratory Volume to Obviate Lung Injury (ALVEOLI) Trial

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a highly morbid condition that has limited therapeutic options. Optimal vitamin D status has been linked to immunological effects that may benefit critically ill patients. Therefore, we investigated whether admission 25-hydroxyvitamin D levels (25OHD) are associated with clinical outcomes in ARDS patients.

METHODS

We performed a secondary analysis of data from a randomized, controlled trial comparing oxygenation strategies in 549 patients with ARDS (NCT00000579). Baseline 25OHD was measured in stored plasma samples. We investigated the relationship between vitamin D status and ventilator-free days (VFD) as well as 90-day survival, using linear regression and Cox proportional hazard models, respectively. Analyses were adjusted for age, race, and Acute Physiology and Chronic Health Evaluation III score.

RESULTS

Baseline 25OHD was measured in 476 patients. 90% of these individuals had 25OHD <20 ng/ml and 40% had 25OHD <10 ng/ml. Patients with 25OHD <20 ng/ml were likely to be ventilated for 3 days longer than patients with levels ≥20 ng/ml (ß 3.41; 95%CI 0.42-6.39: P = 0.02). Patients with 25OHD <10 ng/ml were likely to be ventilated for 9 days longer (ß 9.27; 95%CI 7.24-11.02: P < 0.001) and to have a 34% higher risk of 90-day mortality (HR 1.34; 95% CI 1.06-1.71: P = 0.02) compared to patients with levels >10 ng/ml.

CONCLUSIONS

In patients with ARDS, vitamin D status is associated with duration of mechanical ventilation and 90-day mortality. Randomized, controlled trials are warranted to determine whether vitamin D supplementation improves clinical outcomes in ARDS patients.

Lower serum chloride concentrations are associated with increased risk of mortality in critically ill cirrhotic patients: an analysis of the MIMIC-III database

Background

Cirrhosis can be complicated by electrolyte abnormalities, but the major focus has been concentrated on the clinical significance of serum sodium levels. Emerging studies have identified hypochloremia as an independent prognostic marker in patients with chronic heart failure and chronic kidney disease. The aim of this study was to investigate whether serum chloride levels were associated with mortality of critically ill cirrhotic patients.

Methods

Critically ill cirrhotic patients were identified from the Multi-parameter Intelligent Monitoring in Intensive Care III Database. The primary outcome was ICU mortality. Logistic regression was used to explore the association between serum chloride levels and ICU mortality. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of serum chloride levels for predicting ICU mortality.

Results

A total of 1216 critically ill cirrhotic patients were enrolled in this study. The overall ICU mortality rate was 18.8%. Patients with hypochloremia had a higher ICU mortality than those with non-hypochloremia (34.2% vs. 15.8%; p < 0.001). After multivariable risk adjustment for age, gender, ethnicity, chloride, sodium, Model for End-stage Liver Disease score, Sequential Organ Failure Assessment score, Elixhauser comorbidity index, mechanical ventilation, vasopressors, renal replacement therapy, acute kidney injury, hemoglobin, platelet, and white blood cell, serum chloride levels remained independently associated with ICU mortality (OR 0.94; 95% CI 0.91–0.98; p = 0.002) in contrast to serum sodium levels, which were no longer significant (OR 1.03; 95% CI 0.99–1.08; p = 0.119). The AUC of serum chloride levels (AUC, 0.600; 95% CI 0.556–0.643) for ICU mortality was statistically higher than that of serum sodium levels (AUC, 0.544; 95% CI 0.499–0.590) (p < 0.001).

Conclusions

In critically ill cirrhotic patients, serum chloride levels are independently and inversely associated with ICU mortality, thus highlighting the prognostic role of serum chloride levels which are largely overlooked.

Prevalence and clinical impact of vitamin D deficiency in critically ill Korean patients with traumatic injuries: a single-center, prospective, observational study

Background

This study investigated the prevalence and impact of 25-hydroxyvitamin D (25(OH) vitamin D) deficiency in critically ill Korean patients with traumatic injuries.

Methods

This prospective observational cohort study assessed the 25(OH) vitamin D status of consecutive trauma patients admitted to the trauma intensive care unit (TICU) of Kyungpook National University Hospital between January and December 2018. We analyzed the prevalence of 25(OH) vitamin D deficiency and its impact on clinical outcomes.

Results

There were no significant differences in the duration of mechanical ventilation (MV), lengths of TICU and hospital stays, and rates of nosocomial infection and mortality between patients with 25(OH) vitamin D <20 ng/ml and those with 25(OH) vitamin D ≥20 ng/ml within 24 hours of TICU admission. The duration of MV and lengths of TICU and hospital stays were shorter and the rate of nosocomial infection was lower in patients with 25(OH) vitamin D level ≥20 ng/ml on day 7 of hospitalization. The duration of MV, lengths of TICU and hospital stays, and nosocomial infection rate were significantly lower in patients with increased concentrations compared with those with decreased concentrations on day 7 of hospitalization, but the mortality rate did not differ significantly.

Conclusions

The 25(OH) vitamin D level measured within 24 hours after TICU admission was unrelated to clinical outcomes in critically ill patients with traumatic injuries. However, patients with increased 25(OH) vitamin D level after 7 days of hospitalization had better clinical outcomes than those with decreased levels.

Letter to the editor: Vitamin D levels in acute illness and clinical severity in COVID-19 patients

We would like to comment on the recently published article titled: “Circulating Vitamin D levels status and clinical prognostic indices in COVID-19 patients” by Ricci et al. The authors grouped the patients into two groups according to the vitamin D levels measured at the time of admission into the hospital and reported that lower vitamin D levels are associated with elevated D-dimer and IL-6 levels, low CD4/CD8 ratio and compromised clinical findings with elevated LIPI and SOFA scores. However, review of recent literature shows this association to be debatable. The 25-hydroxyvitamin D levels in the initial phase of critical illness have been reported to drop rapidly and hence consideration of the time of measurement from symptom onset would have enhanced the clinical relevance of these findings. Inferred association between vitamin D levels and disease severity based on SOFA score in COVID-19 patients, needs to be further explored in the light of the recent literature which casts doubt on using SOFA score at admission to predict mortality in COVID-19.

Predicting Discharge Destination of Critically Ill Patients Using Machine Learning

Decision making about discharge destination for critically ill patients is a highly subjective and multidisciplinary process, heavily reliant on the ICU care team, patients and their caregivers' preferences, resource demand, staffing, and bed capacity. Timely identification of discharge disposition can be useful in care planning, and as a surrogate for functional status outcomes following critical illness. Although prior research has proposed methods to predict discharge destination in a critical care setting, they are limited in scope and in the generalizability of their findings. We proposed and implemented different machine learning architectures to determine the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) IV score as well as the patient characteristics that comprise it to predict the discharge destination for critically ill patients within 24 hours of ICU admission. We conducted a retrospective study of ICU admissions within the eICU Collaborative Research Database (eICU-CRD) populated with de-identified clinical data from adult patients admitted to an ICU between 2014 and 2015. Machine learning models were developed to predict four discharge categories: death, home, nursing facility, and rehabilitation. These models were trained and tested on 115,248 unique ICU admissions. To mitigate class imbalance, we used synthetic minority over-sampling techniques. Hierarchical and ensemble classifiers were used to further study the impact of imbalanced testing set on the performance of our predictive models. Amongst all of the tested models, XGBoost provided the best discrimination performance with an area under the receiver operating characteristic curve of 90% (recall: 71%, F1: 70%). Our findings indicate that the variables used in the APACHE IV model for estimating patient severity of illness are better predictors of hospital discharge destination than the APACHE IV score alone. Incorporating these models into clinical decision support systems may assist patients, caregivers, and the ICU team to begin disposition planning as early as possible during the hospitalization.

Unbound Vitamin D Concentrations Are Not Decreased in Critically Ill Patients

OBJECTIVE

Free concentrations of highly protein bound hormones, such as cortisol and thyroxine, are unchanged in critical illness despite substantial decreases in total concentration. Total 25-hydroxyvitamin D (25(OH)D) concentration is decreased in critical illness, but the free concentration of 25(OH)D has had less attention. The aim of this study was to compare total and calculated free 25(OH)D concentrations in critically ill patients with healthy controls.

DESIGN

Case control study.

METHODS

38 patients with critical illness were compared with 68 healthy controls. 25(OH)D was measured by liquid chromatography tandem mass spectrometry (LCMS/MS) and vitamin D binding protein (VDBP) by direct sandwich enzyme-linked immunosorbent assay (ELISA). Total and calculated free 25(OH)D concentrations were compared using unpaired T-tests.

RESULTS

Total 25(OH)D concentrations were significantly lower in critically ill patients than controls (37 (95% CI 31 - 43) vs 57 (53 - 60) nmol/L). Calculated free concentrations of 25(OH)D were not lower in critically ill patients than healthy controls (26 (22 - 29) vs 19 (18 - 20) pmol/L).

CONCLUSIONS

Calculated free 25(OH)D concentrations are not decreased in critical illness. Measuring total 25(OH)D concentrations in patients with critical illness potentially underestimates vitamin D and overestimates the number of patients who are deficient in vitamin D. This article is protected by copyright. All rights reserved.

Admission 25-Hydroxyvitamin D Levels Are Associated With Functional Status at Time of Discharge from Intensive Care Unit in Critically Ill Surgical Patients

BACKGROUND

Vitamin D status is associated with length of stay (LOS) and discharge destination in critically ill patients. To further understand this relationship, we investigated whether admission 25-hydroxyvitaminD (25OHD) levels are associated with discharge functional status in the intensive care unit (ICU).

METHODS

In this retrospective study, data from 2 surgical ICUs at a large teaching hospital were analyzed. 25OHD levels were measured within 24 hours of ICU admission and Functional Status Score for the ICU (FSS-ICU) was calculated within 24 hours of ICU discharge for all patients. To investigate the association of vitamin D status with FSS-ICU, we constructed linear and logistic regression models, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU LOS, and cumulative protein or caloric deficit during ICU admission.

RESULTS

Mean 25OHD level and FSS-ICU was 19 (SD 8) ng/mL and 17 (SD 4), respectively, in the analytic cohort (n = 300). Each unit increase in 25OHD level was associated with a 0.2 increment in FSS-ICU (β = .20; 95% CI 0.14-0.25). Patients with 25OHD levels <20 ng/mL had >3-fold risk of low FSS-ICU (<17) compared with patients with 25OHD >20 ng/mL (OR 3.45; 95% CI 1.96-6.08).

CONCLUSIONS

Our results suggest that vitamin D status at admission is associated with discharge FSS-ICU in critically ill surgical patients. Future studies are needed to validate our results, to build upon our findings, and to determine whether optimizing 25OHD levels can improve functional status and other important clinical outcomes in ICU patients.

Trying to identify who may benefit most from future vitamin D intervention trials: a post hoc analysis from the VITDAL-ICU study excluding the early deaths

Background

Vitamin D supplementation has shown promise for reducing mortality in the intensive care setting. As a steroid prohormone with pleiotropic effects, there may be a lag between administration and observing clinical benefit. This secondary analysis of the VITdAL-ICU study sought to explore whether the effect size of vitamin D on mortality was different when study participants who died or were discharged early were excluded.

Methods

The VITdAL-ICU study was a randomized, placebo-controlled trial in critically ill adults who received placebo or 540,000 IU cholecalciferol followed by monthly supplementation. The effect of vitamin D on 28-day mortality was evaluated after exclusion of participants who died or were discharged within 7 days from study drug administration, according to vitamin D concentrations on day 3, using a bivariate analysis adjusted for confounders and in a stepwise multiple analysis.

Results

Of 475 study participants, 65 died or were discharged within the first 7 days. In the remaining 410 patients, vitamin D supplementation was associated with a reduction in 28-day mortality [OR 0.58 (95% CI 0.35–0.97) p value = 0.035]. The effect on mortality was not significant after adjusting for age, severity scores, female gender, chronic liver and kidney disease, COPD, diagnosis of the tumor, mechanical ventilation, and vasopressors at enrollment (all p > 0.05). In a multiple model, the mortality reduction by vitamin D supplementation did not remain independently significant [OR 0.61 (95% CI 0.35–1.05) p = 0.075].

Vitamin D metabolite response, in the treatment group, demonstrated that survivors at 28 days, had higher levels of 25-hydroxyvitamin D (34.4 vs 25.4 ng/ml, p = 0.010) and 1,25-dihydroxyvitamin D (107.6 vs 70.3 pg/ml, p = 0.049) on day 3. The increase of plasma metabolites after vitamin D oral supplementation, independent of the baseline value, was associated with lower odds of death [OR 0.48 (95% CI 0.27–0.87) p value = 0.016].

Conclusions

High-dose vitamin D3 supplementation was associated with a reduction of 28-day mortality in a mixed population of critically ill adults with vitamin D deficiency when excluding patients who died or were discharged within 7 days after study inclusion. However, this survival benefit was not independently confirmed when adjusted for other factors strongly associated with mortality.

Electronic supplementary material

The online version of this article (10.1186/s13054-019-2472-z) contains supplementary material, which is available to authorized users.

NDVI-based vegetation dynamics and its response to climate changes at Amur-Heilongjiang River Basin from 1982 to 2015

Vegetation in Northern Hemisphere, being sensitive to climate change, plays an important role in the carbon cycles between land and the atmosphere. The response of vegetation to climate change was analyzed at pixel, biome and regional scale in Amur-Heilongjiang River Basin (AHRB) for growing season, spring, summer and autumn using Normalized Difference Vegetation Index and gridded climate data for the period 1982-2015. NDVI and climate variables trend detection methods and correlation analysis were applied. The potential impacts of human activities on growing season NDVI dynamics were investigated further using residual trend analysis. Results showed that at river basin scale, growing season vegetation experienced a discontinuous greening trend with two reversals, demonstrating that NDVI initially increased to mid-1990s, then declined to mid-2000s, and finally rebounded to 2015. This may be attributed to the shifting between drought and wet trends, indicating growing season NDVI was mainly regulated by precipitation. Temperature was the dominant factor on affecting spring vegetation growth while autumn NDVI showed negative correlation with precipitation due to the relation of precipitation with sunshine hours available for photosynthesis. The response of vegetation growth to climatic variations varied among vegetation types. Grassland NDVI exhibited positive correlation with precipitation in all time ranges. NDVI of needleleaved forest, broadleaved forest, mixed forest and woodland were positively correlated with temperature in all seasons, while showing significant negative correlation with autumn precipitation. Residual trend analysis revealed that human activities might lead to the vegetation degradation in China farming zone of AHRB. Fires also play an important role in regulating vegetation dynamics in the region. Results of our analysis can be used by national governments from three countries of AHRB in managing and negotiating vegetation resources of the region.

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

OBJECTIVES

Vitamin D deficiency may be associated with comorbidities and poor prognosis. However, this association in patients in the intensive care unit (ICU) has not been fully elucidated. The aim of this study was to investigate whether the serum concentrations of 25-hydroxyvitamin D (25[OH]D) within the first 48 h after ICU admission are associated with prognostic indicators (Acute Physiology and Chronic Health Evaluation [APACHE] II, Sequential Organ Failure Assessment [SOFA] score, Charlson comorbidity index [CCI]), clinical complications, serum C-reactive protein (CRP) 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 h were analyzed. To evaluate the prognostic factors in the ICU, APACHE II scores, SOFA scores, CCI questionnaires, mechanical ventilation time, CRP, and mortality were used.

RESULTS

The mean concentration of 25(OH)D was 17.7 ± 8.27 ng/mL (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: odds ratio [OR], 1.64; 95% confidence interval [CI], 1.14-2.34) and by age, sex and body mass index (model 2: OR, 1.59; 95% CI, 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% CI, 1.21-9.64) and liver disease (crude model OR, 9.64; 95% CI, 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, mechanical ventilation duration, or 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.

Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients

BACKGROUND

Hospital-acquired pressure injuries (HAPIs) typically develop following critical illness due to immobility and suboptimal perfusion. Vitamin D helps to maintain epithelial cell integrity, particularly at barrier sites such as skin. It is unclear whether vitamin D status is a modifiable risk factor for HAPIs in critically ill patients. Our goal was to investigate the relationship between admission 25-hydroxyvitamin D (25OHD) levels with the development of HAPIs in surgical intensive care unit (ICU) patients.

METHODS

We performed a retrospective cohort study of patients admitted to surgical ICUs at a major teaching hospital in Boston, Massachusetts. To investigate the association of 25OHD levels with subsequent development of HAPIs, we performed logistic regression analyses, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU length of stay, and cumulative ICU caloric or protein deficit.

RESULTS

A total of 402 patients comprised our analytic cohort. Each unit increment in 25OHD was associated with 11% decreased odds of HAPIs (odds ratio [OR] 0.89; 95% CI 0.840.95). When vitamin D status was dichotomized, patients with 25OHD <20 ng/mL were >2 times as likely to develop HAPIs (OR 2.51; 95% CI 1.065.97) compared with patients with 25OHD >20 ng/mL.

CONCLUSION

In our cohort of critically ill surgical patients, vitamin D status at ICU admission was linked to subsequent development of HAPIs. Randomized, controlled trials are needed to assess whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPIs and improve other clinically relevant outcomes in critically ill patients.

Association of admission serum levels of vitamin D, calcium, Phosphate, magnesium and parathormone with clinical outcomes in neurosurgical ICU patients

To evaluate the association of admission serum levels of 25(OH)D, parathormone and the related electrolytes with severity of illness and clinical outcomes in neurosurgical critically ill patients, serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate, along with APACHE II score were measured for 210 patients upon admission. Mean serum 25(OH)D was 21.1 ± 7.4 ng/mL. 25(OH)D deficiency (less than 20 ng/dL) and elevated serum parathormone level were found in 47.6% and 38% of patients respectively. Hypocalcaemia, hypophosphatemia, hypomagnesaemia and hypermagnesaemia were found in 29.5%, %63.8, 41.9% and 27.6% of patients respectively. The APACHE II score was significantly correlated with serum levels of 25(OH)D, parathormone, calcium, and phosphate. Multivariate regression analysis adjusted by other risk factors showed that among all clinical outcomes, admission hypovitaminosis D was associated with longer duration of ICU stay and a high admission of parathormone was associated with in ICU mortality. We concluded that disorders of admission serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate are related to the presence of multiple causal factors such as severity of disease and are not independently associated with clinical outcomes. Most often they are normalize spontaneously with resolution of the disease process.

Vitamin D kinetics in the acute phase of critical illness: A prospective observational study

PURPOSE

The objective of this study was to assess the vitamin D kinetics in critically ill patients by performing periodic serum vitamin D measurements in short time intervals in the initial phase of a critical illness.

MATERIALS AND METHODS

We performed vitamin D serum measurements: at admission and then in 12-hour time intervals. The minimum number of vitamin D measurements was 4, and the maximum was 8 per patient.

RESULTS

A total of 363 patients were evaluated for participation, and 20 met the inclusion criteria. All patients had an initial serum vitamin D level between 10.6 and 39ng/mL. Nineteen patients had vitamin D levels between 10 and 30ng/mL, which means that they had vitamin D insufficiency or deficiency, and only one patient had a normal vitamin D serum plasma level. We observed that the median of the vitamin D level decreases until the fourth measurement then stabilizes around the 4th and 5th measurement and then appears to increase unevenly. The highest drop is at the very beginning.

CONCLUSIONS

The vitamin D serum level is changeable in the initial phase of a critical illness. We hypothesize that the serum vitamin D concentration can mirror the severity of illness.

Vitamin D Status and Supplementation in the Critically Ill

Vitamin D deficiency has recently been recognized as a widespread global disorder. Generally considered a direct extension of malnutrition, even subclinical hypovitaminosis D is now recognized in adequately nourished populations. Compared to the general population, the prevalence of hypovitaminosis D is greater in the critically ill population. In fact, several studies have shown poorer outcomes in critically ill patients discovered to be vitamin D deficient or insufficient. Controversy persists regarding vitamin D measurements, quantity of supplementation, and appropriate target level in various populations. Vitamin D has a vital role in calcium homeostasis and extra-skeletal health, such as immune function. Therefore, vitamin D supplementation may have a role for improving outcomes in critically ill patients. In this review, we will first discuss the metabolism and function of vitamin D under normal physiologic conditions. We will then explore the prevalence and prognostic value of vitamin D deficiency in critical illness. Finally, we will examine recent trials focusing on appropriate dosing, route of administration, and outcomes associated with vitamin D supplementation in the ICU.