Addition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired Pneumonia

Bilgili

et al. 2016

J Infect Dev Ctries

Introduction: Vitamin D plays a role in host defense and is known to be associated with mortality in patients in the intensive care unit (ICU). We aimed to evaluate the relationships between vitamin D levels and predictors of mortality in patients with ventilator-associated pneumonia (VAP) caused by extensively drug-resistant Acinetobacter baumanii (XDR A. baumanii). Results: Forty-for patients were studied over six months. All patients had vitamin D deficiency. The 28-day mortality in patients with 25(OH)D levels ≤ 10 ng/mL was higher than in patients with 25(OH)D > 10ng/mL (p = 0.001). The fourth-and seventh-day SOFA scores (p= 0.04 and p= 0.001) and first-and fourth-day procalcitonin levels (p = 0.03 and p = 0.004) were higher in patients with 25(OH)D levels ≤ 10 ng/mL. The clinical scores (SOFA, CPIS, and CEPPIS) and biomarkers (NT-proBNP, PCT) were negatively correlated with 25(OH)D levels in all study groups. Conclusions: Severe vitamin D deficiency was associated with adverse outcome in VAP due to XDR A. baumanii. Vitamin D levels may be a prognostic predictor of VAP. It is also important to evaluate the effect of rapid vitamin D replacement on mortality.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vitamin D level is associated with mortality predictors in ventilator-associated pneumonia caused by Acinetobacter baumannii

Bilgili

et al. 2016

J Infect Dev Ctries

“…Data from observational studies have indicated that vitamin D insufficiency is related to disease severity and prognosis [17][27] [28] but the results of our systematic review indicate that current evidence from RCTs does not support any change in practice. There is a need to conduct more placebo-controlled double blinded RCTs with adequate sample size, and appropriate dosage (discussed further below) for evaluating the safety and efficacy of vitamin D as an adjunct to antibiotics for childhood pneumonia of varying severity.…”

Section: Implications For Practice and Researchmentioning

confidence: 72%

Vitamin D as an adjunct for acute community-acquired pneumonia among infants and children: systematic review and meta-analysis

Bhaumik¹,

Lassi²

2017

Wiki J Med

Plain language summaryPneumonia is the most important cause of death in children under five years old. Most deaths occurs in children in low-and middle-income countries who have poor nutrition and lower immunity. Standard medical therapy consists of antibiotics and supportive care.Vitamin D is cheap and known to improve the immune system response against respiratory diseases such as tuberculosis. Previous studies have examined whether vitamin D supplements are useful to prevent pneumonia, but less attention has been paid to the use of vitamin D to aid in the treatment of pneumonia.This study searched the literature and found three clinical trials of vitamin D as an additional treatment for pneumonia in children. These trials were from India or Afghanistan and included 997 infants and children in total. Taken together, these trials showed no effect of vitamin D cure rates, mortality, time to clinical recovery or duration of hospital stay for pneumonia in children. The quality of evidence is however low.The authors conclude that current evidence is limited but does not support the use of vitamin D supplements during treatment of pneumonia in children. Further trials are needed on this topic. AbstractBackground: Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity among infants and children, particularly in low and middle income countries. Vitamin D, which plays a role in innate as well as adaptive immunity, is a candidate low-cost intervention as an adjunct for treatment of CAP.

Anaesthesiol Intensive Ther

“…In the extra-hospital population, low levels of vitamin D are positively correlated with the incidence and severity of respiratory infections [14]. In some viral infectious diseases, (e.g., influenza), low concentrations of vitamin D can be a risk factor of infection or its more severe course [15].…”

Section: Pleiotropic Action Of Vitamin Dmentioning

confidence: 99%

Vitamin D in critically ill patients

Matysiak-Luśnia

2016

Vitamin D deficiency is a commonly observed global phenomenon, both in the general population and in hospitalized patients, including critically ill patients. Vitamin D deficiency is associated with multiple adverse health outcomes, including increased morbidity and mortality in the general population and in critically ill patients. Vitamin D is a fatsoluble vitamin that plays an important role in bone metabolism. However, Vitamin D is also a steroid hormone that exerts multiple pleiotropic effects. Vitamin D regulates immunity, inflammation, cell proliferation, differentiation, apoptosis, and angiogenesis. There is growing evidence of a close relationship between vitamin D insufficiency and various systemic disorders, i.e., type II diabetes, certain types of cancer, obesity, and cardiovascular morbidities. The purpose of this article is to present the current knowledge on the relationship between vitamin D status and critical illness. Key words: vitamin D, critical illness, intensive care, critically illAnaesthesiology Intensive Therapy 2016, vol. 48, no 3, 201-207 There is mounting evidence of the role of vitamin D in blood serum as a factor determining the course and prognosis of numerous diseases. Knowledge of the molecular basis of vitamin D action, its extraosseous effects and its significant role in the prevention and treatment of chronic diseases, especially inflammatory diseases, is growing. This paper presents the current state of knowledge regarding vitamin D, particularly its role in critically ill patients treated in intensive care units (ICUs). PRODUCTION AND METABOLISM OF VITAMIN DVitamin D belongs to the group of steroid chemical compounds with the general formula C 28 H 43 OH. The group contains vitamin D1 (a mixture of cholecalciferol and lumisterol occurring in cod liver oil, a compound with a similar structure as vitamin D but without the same activity), vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D2 occurs in plants, whereas vitamin D3 is produced in human and animal skin, mainly in the keratocytes of the proliferative epithelium, mediated by ultraviolet radiation (specifically UVB radiation). The compounds are activated in the liver by hydroxylation to 25-hydroxyderivatives and subsequently in other organs to 1,25-dihydroxyderivatives. The latter conversion occurs primarily in the kidneys and is mediated by parathormone (PTH). Calcitriol (1,25-dihydroxycholecalciferol) is an active form of vitamin D3, a substance of hormonal action regulating many organs and tissues. Although the metabolic effects of vitamin D2 and vitamin D3 are similar, they bind with different types of plasma proteins. As a result, the action of vitamin D3 is longer and 2-10-fold more effective than vitamin D2.Vitamin D3 is one of a few vitamins that the body is able to produce endogenously; therefore, it does not fulfil the definition of a vitamin. Ultraviolet radiation is required for the production of Vitamin D3 in the body, more specifically UVB (wavelength of 280−315 nm), which e...