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Geiger C, McNally JD, Christopher KB, Amrein K. Vitamin D in the critically ill - update 2024. Curr Opin Clin Nutr Metab Care 2024; 27:515-522. [PMID: 39302310 DOI: 10.1097/mco.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize the latest publications on vitamin D focused on critically ill patients. RECENT FINDINGS Vitamin D deficiency is common in critically ill patients (children and adults) and associated with a higher risk for mortality and morbidity as well as sepsis, acute respiratory failure, acute renal failure and prolonged ICU stay. As it is an inexpensive substance with a wide safety margin, acute treatment in form of a loading dose in addition to ongoing maintenance therapy is an interesting option in the ICU. The potential benefit of acute native (biologically inactive) vitamin D treatment has not fully been answered but even a small survival benefit demonstrable in very large analyses could be relevant to critical care. To date, less than 5000 patients cumulative have been enrolled in randomized controlled trials concerning vitamin D, with substantial heterogeneity in trial design regarding population (with or without deficiency, coronavirus disease 2019, different age groups, underlying illnesses), metabolite, dosing, outcome, and more. SUMMARY More research is needed, but vitamin D supplementation represents a simple intervention with an excellent safety profile. As adequate vitamin D is essential to the health of multiple organ systems, rapid normalization of deficiency states could translate to benefits across the wide range of diagnoses and organ dysfunctions experienced in the ICU setting. As a minimum, we recommend administering the standard daily dose of vitamin D3 in the critically ill patient.
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Affiliation(s)
- Christina Geiger
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
| | | | - Kenneth B Christopher
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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Cutuli SL, Ferrando ES, Cammarota F, Franchini E, Caroli A, Lombardi G, Tanzarella ES, Grieco DL, Antonelli M, De Pascale G. Update on vitamin D role in severe infections and sepsis. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:4. [PMID: 38263252 PMCID: PMC10804708 DOI: 10.1186/s44158-024-00139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
Severe infections frequently require admission to the intensive care unit and cause life-threatening complications in critically ill patients. In this setting, severe infections are acknowledged as prerequisites for the development of sepsis, whose pathophysiology implies a dysregulated host response to pathogens, leading to disability and mortality worldwide.Vitamin D is a secosteroid hormone that plays a pivotal role to maintain immune system homeostasis, which is of paramount importance to resolve infection and modulate the burden of sepsis. Specifically, vitamin D deficiency has been widely reported in critically ill patients and represents a risk factor for the development of severe infections, sepsis and worse clinical outcomes. Several studies have demonstrated the feasibility, safety and effectiveness of vitamin D supplementation strategies to improve vitamin D body content, but conflictual results support its benefit in general populations of critically ill patients. In contrast, small randomised clinical trials reported that vitamin D supplementation may improve host-defence to pathogen invasion via the production of cathelicidin and specific cytokines. Nonetheless, no large scale investigations have been designed to specifically assess the impact of vitamin D supplementation on the outcome of critically ill septic patients admitted to the intensive care unit.
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Affiliation(s)
- Salvatore Lucio Cutuli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Fabiola Cammarota
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Franchini
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Caroli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianmarco Lombardi
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eloisa Sofia Tanzarella
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Luca Grieco
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Antonelli
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gennaro De Pascale
- Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Istituto Di Anestesiologia E Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.
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Kahar LA, Yusrawati Y, Jamsari J, Maskoen T, Aribowo K, Sari WM. Vitamin D-Binding Protein and the Role of its Gene Polymorphisms in the Mortality of Sepsis Patients. Acta Med Acad 2023; 52:212-220. [PMID: 38407088 PMCID: PMC10945317 DOI: 10.5644/ama2006-124.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/21/2023] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE This study aimed to determine the role of vitamin D-binding protein (VDBP) gene polymorphisms (especially at locus rs7041), vitamin D-binding protein levels, and vitamin D levels in mortality in sepsis patients. PATIENTS AND METHODS We performed the analytic observational study with a case-control approach. A total of 80 patients were included in this study, 40 patients were grouped as the case group and 40 patients were grouped as the control group. The patients were diagnosed with sepsis and treated in the Intensive Care Unit (ICU), M. Djamil Hospital, Indonesia. The VDBP rs7041 gene polymorphism was analyzed using the polymerase chain reaction procedure. VDBP and vitamin D levels were examined using the enzyme-linked immunosorbent assay (ELISA) method. RESULTS The case group showed lower mean vitamin D and VDBP levels than the control group (P<0.05). There were more variations in the rs7041 gene VDBP (mutant) locus in the case group than in the control group, and this difference was considered statistically significant, P<0.05. The results of this study indicate that the occurrence of polymorphism or variations at locus rs7401 (mutant) causes a decrease in VDBP and vitamin D levels. A decrease in vitamin D levels correlates with the incidence of mortality in sepsis patients. CONCLUSION Polymorphism gene VDBP at locus rs7041 causes a decrease in the production of VDBP, a vitamin D carrier protein.
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Affiliation(s)
- Liliriawati Ananta Kahar
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Andalas University, M. Djamil Hospital, Padang, Indonesia.
| | - Yusrawati Yusrawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Andalas University, Padang, Indonesia
| | - Jamsari Jamsari
- Department of Biotechnology, Postgraduate Program, Andalas University, Padang, Indonesia
| | - Tinni Maskoen
- Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - Kornelis Aribowo
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Andalas University, Padang, Indonesia
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Ananta Kahar L, Yusrawati Y, Jamsari J, Maskoen T, Aribowo K, Monika Sari W. The Role of Vitamin D Binding Protein and Vitamin D Level in Mortality of Sepsis Patients. Rep Biochem Mol Biol 2023; 12:366-373. [PMID: 38618268 PMCID: PMC11015934 DOI: 10.61186/rbmb.12.3.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/15/2023] [Indexed: 04/16/2024]
Abstract
Background Vitamin D plays crucial roles in immune cell function, including macrophage activation, immune response modulation, and antimicrobial peptide production. Low vitamin D levels can result in reduced immune response, heightened inflammation, and impaired organ function, thereby exacerbating sepsis severity and impacting patient prognosis. This study investigates the influence of vitamin D binding protein expression and vitamin D levels on the mortality of septic patients. Methods This analytical observational study employs a case-control approach and involves patients at the Critical Care Unit of Dr. M. Djamil General Hospital in Padang, Indonesia. The study comprises 40 patients in the case group and 40 patients in the control group. Vitamin D and vitamin D binding protein levels are assessed using the enzyme-linked immunosorbent assay method. Results Vitamin D and vitamin D binding protein levels were observed to be lower in the case group compared to the control group. In the case group, the majority of patients had vitamin D binding protein levels below 200 µg/mL. A significant association was found between vitamin D levels and mortality in sepsis patients (P< 0.05). Patients with vitamin D levels below 20 µg/mL faced a 2.54 times higher risk of mortality than those with levels exceeding 20 µg/mL. Conclusions Diminished levels of vitamin D binding protein and vitamin D contribute to an increased risk of mortality in septic patients.
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Affiliation(s)
- Liliriawati Ananta Kahar
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Andalas University, Dr. M. Djamil General Hospital, Padang, 25171, Indonesia.
| | - Yusrawati Yusrawati
- Department of Obstetrics and Gynecology, Faculty of Medicine, Andalas University, Padang, 25171, Indonesia.
| | - Jamsari Jamsari
- Department of Biotechnology, Postgraduate Program, Andalas University, Padang, 25163, Indonesia.
| | - Tinni Maskoen
- Faculty of Medicine, Padjadjaran University, Bandung, 45363, Indonesia.
| | - Kornelis Aribowo
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Andalas University, Padang, 25171, Indonesia.
| | - Wiwi Monika Sari
- Intensive Care Unit, Dr. M. Djamil General Hospital, Padang, 25171, Indonesia.
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