Effects of vitamin D deficiency in critically ill surgical patients

Presented at the 2011 annual meeting of the Midwest Surgical Association, Galena, Illinois.
The American Journal of Surgery; doi:10.1016/j.amjsurg.2011.09.012
Lisa Flynn M.D.a, Lisa Hall Zimmerman Pharm.D.b, Kelly McNorton Pharm.D.b, Mortimer Dolman M.D.c, James Tyburski M.D.a, Alfred Baylor M.D.a, Robert Wilson M.D.a, Heather Dolman M.D.a, hdolman@med.wayne.edu
a Department of Surgery, Wayne State University, School of Medicine, Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
b Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, MI, USA
c Department of Endocrinology, Mount Carmel East Hospital, Columbus, OH, USA
Received 25 July 2011; revised 25 September 2011; Available online 28 December 2011.

Background: The incidence of vitamin D deficiency in critically ill patients is reported to be up to 50%, with a 3-fold increase in predicted mortality, but limited data exist concerning vitamin D deficiency in critically ill surgical patients.

Methods Sixty-six adult surgical intensive care unit patients who had 25-hydroxyvitamin D serum levels evaluated from January 2010 to February 2011 were prospectively identified. Patients were divided into groups according to vitamin D level (<20 vs ?20 ng/mL).

Results Of the 66 patients evaluated, 49 (74%) had vitamin D levels < 20 ng/mL, and 17 (26%) had vitamin D levels >20 ng/mL.

Patients with vitamin D levels < 20 versus >20 ng/mL had longer lengths of hospital stay.
Lengths of intensive care unit stay were clinically longer, although not significant.
Infection rates tended to be higher (P = .09), and a higher incidence of sepsis was seen in the patients with vitamin D levels < 20 ng/mL.

Conclusions Vitamin D levels < 20 ng/mL have a significant impact on length of stay, organ dysfunction, and infection rates.
More data are needed on the value of supplementation to improve these outcomes.

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See also VitaminDWiki

• All items in after Surgery or Trauma 351 items
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• More sepsis deaths when active vitamin D (Calcitrol) was low – May 2013
• ICU time is 2X more likely to be longer than 2 days if vitamin D less than 20 ng – Mar 2011
• Health Care Providers save $ by providing vitamin D before and/or after surgery or trauma - reduces the time in bed, etc.
• Virtually all veterans in ICU had vitamin D less than 32 ng – Jan 2011
• Critical Care patients with low vitamin D were 85 percent more likely to die – Sept 2011
• Veterans with enough vitamin D were almost 2X more likely to survive ICU – Oct 2010
• Study: 540,000 IU oral to ten patients near death in an ICU as a single dose achieved around 40 ng/ml, but it takes three days to do so
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• Only 200 IU vitamin D in intravenous feeding of multivitamins – Aug 2012
• Vitamin D might reduce sepsis
• MRSA inpatient cost 2X higher if less than 20 ng vitamin D – June 2011
• Staph infection reduced 50 percent when have more than 30 ng of vitamin D – Aug 2011
• Septic patients vitamin D so low that small changes did not matter – June 2011
• Sepsis associated with low vitamin D - April 2012
• 5 days longer in ICU if low on vitamin D - April 2012

See also web

• Sepsis and vitamin D: A look at the research Vitamin D Council Oct 2012
  Sepsis is the second-leading cause of death in ICUs
  tenth-most-common cause of death overall.
  It occurs in up to 2% of all hospitalizations and accounts for as much as 25% of ICU bed utilization
  with mortality rates ranging from 20% for sepsis and 40% for severe sepsis
• Random Controlled Trial: Sepsis and 2mg of Calcitriol
• Vitamin D is not a Predictor for Sepsis in ICU CHEST Journal
  of 81 ICU patients no statistical difference of having sepsis and low vitamin D
  sepsis 13 ng, no sepsis 14 ng - Poster presentation Oct 24, 2012