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

Brook, Karolina; Otero, Tiffany M. N.; Yeh, D. Dante; Canales, Cecilia; Belcher, Donna; Quraishi, Sadeq A.

doi:10.1002/ncp.10196

Cited by 6 publications

(6 citation statements)

References 96 publications

(113 reference statements)

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“…D status was associated with prolong poor functional status at time of discharge from intensive care unit in critical ill surgical patients. 89 Perioperatively, the evidence from in vivo studies have shown that low level of 25(OH)D was associated with delay wound healing, longer emergence time and increased risk of postoperative cognitive impairment. 69,90,91 Clinically, preoperative vitamin D status in patients undergoing non-cardiac surgery was associated with infectious complication and respiratory complication related to general anesthesia.…”

Section: Vitamin D Air Pollution and Effects On Organ Transplantationmentioning

confidence: 99%

“…The studies in critically‐ill patients had found that vitamin D insufficiency was associated with risks of respiratory infection, sepsis, respiratory and kidney failure, increased time of ventilator, intensive care unit (ICU) stay, and mortality 71,74,76,88 . Furthermore, low vitamin D status was associated with prolong poor functional status at time of discharge from intensive care unit in critical ill surgical patients 89 …”

Section: Introductionmentioning

confidence: 99%

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Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations

Supphapipat,

Leurcharusmee,

Chattipakorn

et al. 2023

Clinical Transplantation

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IntroductionAir pollution is a worldwide problem affecting human health via various body systems, resulting in numerous significant adverse events. Air pollutants, including particulate matter < or = 2.5 microns (PM2.5), particulate matter < or = 10 microns (PM10), ozone (O3), nitrogen dioxide (NO2), and traffic‐related air pollution (TRAP), have demonstrated the negative effects on human health (e.g., increased cerebrovascular, cardiovascular, and respiratory diseases, malignancy, and mortality). Organ transplant patients, who are taking immunosuppressive agents, are especially vulnerable to the adverse effects of air pollutants. The evidence from clinical investigation has shown that exposure to air pollution after organ transplantation is associated with organ rejection, cardiovascular disease, coronary heart disease, cerebrovascular disease, infection‐related mortality, and vitamin D deficiency.Objectives and methodThis review aims to summarize and discuss the association of exposure to air pollutants and serum 25‐hydroxyvitamin D level and outcomes after transplantation. Controversial findings are also included and discussed.ConclusionAll of the findings suggest that air pollution results in a hazardous environment, which not only impacts human health worldwide but also affects post‐transplant outcomes.

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Section: Vitamin D Air Pollution and Effects On Organ Transplantationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations

Supphapipat,

Leurcharusmee,

Chattipakorn

et al. 2023

Clinical Transplantation

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“…Pre-clinical data suggest that not only is vitamin D a potent anti-inflammatory agent, 10 but that it is essential for epithelial cell growth and differentiation, 11 expression of endogenous antimicrobial peptides at barrier (e.g., skin, gut, lungs) sites, 12 and promoting optimal platelet function. 13 Observational studies by members of our group suggest that vitamin D status is associated with duration of mechanical ventilation, 14 functional status at ICU discharge, 15 disposition after acute care hospitalization, 16 and mortality in critically ill patients. 17 High-dose vitamin D supplementation has even been shown by members of our group 18 and others 19 to improve clinical outcomes in critically ill patients with low baseline 25-hydroxyvitamin D (25OHD) levels.…”

Section: Introductionmentioning

confidence: 99%

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

Quraishi

Bhan

Matthay

et al. 2021

J Intensive Care Med

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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.

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“…Brook and others in a recent issue of our journal reported that admission 25‐hydroxy vitamin D (25OHD) level in critically ill patients was associated with discharge functional status score. Higher scores implying better functional status were associated with higher initial 25OHD levels.…”

mentioning

confidence: 99%

Ongoing Problems with Research on Vitamin D in Critical Illness. Comment on Admission 25‐hydroxyvitamin D levels are associated with functional status at time of discharge from intensive care unit in critically ill surgical patients

Sriram

2019

Nut in Clin Prac

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Brook and others in a recent issue of our journal 1 reported that admission 25-hydroxy vitamin D (25OHD) level in critically ill patients was associated with discharge functional status score. Higher scores implying better functional status were associated with higher initial 25OHD levels. The authors suggest that studies are needed to determine if correcting low 25OHD levels (to a level of about 30 ng/mL) can improve discharge functional status of intensive care unit (ICU) patients.The study group included patients specifically recruited for this study as well as a smaller number from previously published studies on the association of vitamin D status and mechanical ventilation and mortality. In the present combined report, blood samples were collected in 300 patients within 24 hours of admission to the ICU.Many publications have reported low vitamin D levels in critically ill patients, as detailed in the present paper, but the significance of vitamin D status and the need to correct it are not well understood. As we have pointed out in an earlier publication, 2 25OHD levels obtained after ICU admission do not accurately reflect premorbid vitamin D status, as fluid resuscitation causing significant hemodilution most often begins in the emergency department even prior to transfer to an actual ICU bed. Levels further decrease during continued fluid administration, leading to false low levels when blood samples are collected 24 hours later. Although newer recommendations are to limit fluid administration in postsurgical patients and in septic shock, adequate resuscitation with fluids is the first and immediate line of therapy for hemodynamically unstable patients. Thus, many (but certainly not all) of the previous publications on the role of vitamin D in critical illness have not accurately identified deficiency states. Patients who were never vitamin D deficient are wrongly classified as such. Decreases in levels of other micronutrients (eg, selenium, thiamine) after cardiac surgery, where massive fluid shifts are inevitable, have also been reported. 3,4 In a previous study, we obtained blood samples at the time of induction of anesthesia in cardiac surgery patients, providing data for the genuine premorbid vitamin D status.We found no association between 25OHD levels and postoperative cardiac function, dysglycemia, and length of stay, all of which can affect eventual functional status. 5 The authors conclude that "admission vitamin D status may be a modifiable risk factor" to influence better functional status at discharge. We submit that such a study is not feasible, unless we have truly premorbid (ie, prior to hospital visit or transfer to ICU from a floor bed) levels, something that is quite difficult, if not impossible, to predict and obtain. References 1. Brook K, Otero TMN, Yeh, DD et al. Admission 25-hydroxyvitamin D levels are associated with functional status at time of discharge from intensive care unit in critically ill surgical patients. Nutr Clin Pract. 2019;34(4):572-580. 2. Sriram K, Meguid MM. The...

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

Cited by 6 publications

References 96 publications

Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations

Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations

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

Ongoing Problems with Research on Vitamin D in Critical Illness. Comment on Admission 25‐hydroxyvitamin D levels are associated with functional status at time of discharge from intensive care unit in critically ill surgical patients

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