Association between Vitamin D supplementation and mortality in critically ill patients: A systematic review and meta-analysis of randomized clinical trials

Abstract

Background Observational studies suggest that low 25-hydroxyvitamin D status is common and has been associated with higher mortality in critically ill patients. This study aim to investigate whether vitamin D supplementation is associated with lower mortality in critically ill patients. Method We searched Medline, Embase, and Cochrane databases from inception to January 12, 2020, without language restrictions, for randomized controlled trials comparing the effect of vitamin D supplementation with placebo in critically ill patients. Two authors independently performed data extraction and assessed study quality. The primary outcome was all-cause mortality at the longest follow-up. Result We identified nine trials with a total of 2066 patients. Vitamin D supplementation was not associated with reduced all-cause mortality at the longest follow-up (RR 0.90, 95% CI 0.74 to 1.09, I2 = 20%), at 30 days (RR 0.81, 95% CI 0.56 to 1.15), at 90 days (RR 1.15, 95% CI 0.92 to 1.44), and at 180 days (RR 0.82, 95% CI 0.65 to 1.03). Results were similar in the sensitivity analysis. The sample size met the optimum size in trial sequential analysis. Similarly, supplemental vitamin D was not associated with length of ICU stay, hospital stay, or mechanical ventilation. Conclusion Vitamin D supplement was not associated with reduced all-cause mortality in critically ill patients. Systematic review registration Open Science Framework https://osf.io/bgsjq

Vitamin D in critical care: where are we now and what is next?

“…Many completed and ongoing vitamin D RCTs assumed ridiculously large, unplausible treatment effects, allowing for small sample sizes and feasibility of a trial, usually in an academic setting. Peng et al [35] described a nonsignificant 10% all-cause mortality reduction at the longest follow-up. If true, this is a very large benefit and twice as high as the highest plausible mortality reduction for intensivists [42].…”

“…Many completed and ongoing vitamin D RCTs assumed ridiculously large, unplausible treatment effects, allowing for small sample sizes and feasibility of a trial, usually in an academic setting. Peng et al [35] described a nonsignificant 10% all-…”

“…To date, five meta-analyses on vitamin D in the adult ICU have been published (three in 2017 and two in 2020) [34][35][36][37][38][39] as opposed to eight vitamin D RCTs in the mixed ICU and two in neurocritical care. The majority of the trials used a single bolus dose and gave no maintenance dose.…”

Administration of vitamin D and its metabolites in critically ill adult patients: an updated systematic review with meta-analysis of randomized controlled trials

“…We systematically searched the following databases from database launch to February 9, 2022: MEDLINE, EMBASE and CENTRAL (Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials) through OVID, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) through EBSCOhost. In addition, we searched for additional articles from published systematic reviews [11][12][13][14], personal records, contacts and ClinicalTrials.gov for ongoing studies.…”

Rays of immunity: Role of sunshine vitamin in management of COVID-19 infection and associated comorbidities

“…Vitamin D cuts the rate of Severe or moderate chronic obstructive pulmonary disease (COPD) worsening [46]. Another meta-analysis forecasted that vitamin D was not in correlation with length of hospital stay, ventilation or intensive care unit (ICU) [47]. Vitamin D deficiency in the course of pregnancy might increase the chances of childhood eczema [48].…”