Mehmet Sinan İYİSOY, Faruk CİCEKCİ, Gülçin HACIBEYOĞLU, Şule ARICAN, İlkay TOPBAL

Is vitamin D deficiency associated with mortality in intensive care patients? An observational retrospective study

Aim: The objective of this study is to investigate effects of vitamin D levels in intensive care patients on length of stay in intensive care unit and duration of hospitalization, and the need for mechanical ventilation.Material and Methods: This study was conducted as a retrospective study between February 2015 and January 2016. Length of stay in the intensive care unit and duration of hospitalization, and the need for mechanical ventilation were compared among all patients who were admitted to the intensive care unit and whose 25 (OH) D levels were examined. We further investigated whether vitamin D levels have an effect on 30-day mortality.Results: A total of 155 patients were included in the study. Vitamin D deficiency was found in 123 (79%) patients, and vitamin D insufficiency in 21 (13%) patients, while vitamin D levels were evaluated as normal in the remaining 11 (7%) patients. The effects of 25(OH)D levels of the patients on the length of stay in the intensive care unit (P=0.302), duration of hospitalization (P=0.363), and the need for mechanical ventilation (P=0.150) were not statistically significant. No statistically significant difference was observed between the mortality rates according to vitamin D levels (P=0.377).Conclusion: We found that 25 (OH) D vitamin levels were significantly low in intensive care patients. Although it is difficult to achieve a clear result because of a wide range of comorbidities in intensive care unit patients, we believe that further prospective randomized studies are warranted to clarify this issue.

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Flynn L, Zimmerman LH, McNorton K, Dolman M, Tyburski J, Baylor A, et al. Effects of vitamin D deficiency in critically ill surgical patients. Am J Surg 2011;203(3):379-82.
Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin d deficiency to clinical out comes in critically ill patients. JPEN J Parenter Enteral Nutr 2012;36(6):713-20.
Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB. Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Crit Care Med 2012;40(1):63-72.
Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg 2012;204(1):37-43.
Cecchi A, Bonizzoli M, Douar S, Mangini M, Paladini S, Gazzini B, et al. Vitamin D deficiency in septic patients at ICU admissionis not a mortality predictor. Minerva Anestesiol 2011;77(12):1184-9.
Hu J, Luo Z, Zhao X, Chen Q, Chen Z, Qin H, et al. Changes in the calcium-parathyroid hormone-vitamin d axis and prognosis for critically ill patients: a prospective observational study. PLoS One.2013;8(9)e75441.
Joshi A, Bhadade R, Varthakavi PK, DeSouza R, Bhagwat NM, Chadha MD. Vitamin D deficiency is associated with increased mortality in critically ill patients especially in those requiring ventilatory support. Indian J Endocrinol Metab 2014;18(4):511-5.
Aird WC: Endothelium as an organ system. Crit Care Med 2004;32(5 Suppl):271-9.
Brock K, Wilkinson M, Cook R, Lee S, Bermingham M. Associations with vitamin D deficiency in “at risk” Australians. J Steroid Biochem Mol Biol 2004;89-90(1- 5):581-8.
Sambrook PN, Cameron ID, Cumming RG, Lord SR, Schwarz JM, Trube A, et al. Vitamin D deficiency is common in frail institutionalised older people in northern Sydney. Med J Aust 2002;176(11):560.
Krishnan A, Ochola J, Mundy J, Jones M, Kruger P, Duncan E, et al. Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. Crit Care 2010;14(6):R216.
Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, et al. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med 2011;39(4):671-7.
Lucidarme O, Messai E, Mazzoni T, Arcade M, du Cheyron D. Incidence and risk factors of vitamin D deficiency in critically ill patients: Results from a prospective observational study. Intensive Care Med 2010;36(9):1609‑11.
Quraishi SA, Bittner EA, Blum L, McCarthy CM, Bhan I, Camargo CA Jr. Prospective study of vitamin D status at initiation of care in critically ill surgical patients and risk of 90-day mortality. Crit Care Med 2014;42(6):1365-71.
Lee P, Nair P, Eisman JA, Center JR. Vitamin D deficiency in the intensive care unit: an invisible accomplice to morbidity and mortality? Intensive Care Med 2009;35(12):2028-32.
Venkatram S, Chilimuri S, Adrish M, Salako A, Patel M, DiazFuentes G. Vitamin D deficiency is associated with mortality in the medical intensive care unit. Crit Care 2011;15(6):R292.
Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 2011;25(5):769-81.
Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010;95(2):471-8.
Özkan B, Döneray H. D vitamininin iskelet sistemi dışı etkileri. Çocuk Sağlığı ve Hastalıkları Dergisi. 2011;54(2):99-119.
Amrein K, Venkatesh B. Vitamin D and the critically ill patient. Curr Opin Clin Nutr Metab Care 2012;15(2):188-93.
Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116(8):2062-72.