Severe vitamin D deficiency is common in critically ill patients at a high northern latitude

Kvaran, Rúnar Bragi; Sigurðsson, Martin I; Skarphedinsdottir, S. J.; Sigurðsson, Gunnar

doi:10.1111/aas.12748

Cited by 7 publications

(10 citation statements)

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“…In the present study, we found that a large majority of the ICU patients in our sample (89.4%) had Vit D deficiency/insufficiency. This finding is consistent with the reported high prevalence of hypovitaminosis D in the general population in Tunisia (Meddeb et al, 2005) and in ICU patients worldwide (Alizadeh et al, 2015;Amrein et al, 2014;Ardehali et al, 2018;Kvaran et al, 2016;Lucidarme et al, 2010;Quraishi et al, 2014;Shojaei et al, 2019;Vassiliou et al, 2018). The main causes of low Vit D status in these patients are advanced age, immobilization, and lack of adequate sunlight exposure for adequate endogenous Vit D synthesis (Holick, 2007).…”

Section: Discussionsupporting

confidence: 87%

“…Researchers have reported that low plasma 25(OH)D at admission predicts unfavorable outcomes such as need for mechanical ventilation (Ardehali et al, 2018;Ebenezer et al, 2016), organ failure (Braun et al, 2011) Lucidarme et al, 2010), systemic bloodstream infection (Amrein et al, 2014;Braun et al, 2011), ICU-AI (Ebenezer et al, 2016;Quraishi et al, 2013), VAP (De Pascale et al, 2016;Vassiliou et al, 2018), and all-cause mortality (Braun et al, 2011;Moraes et al, 2015;Moromizato et al, 2014) in critically ill patients. However, others studies have shown no significant association of plasma 25(OH)D with unfavorable outcomes such as organ failure (Ala-Kokko et al, 2016), septic shock (Ratzinger et al, 2017;Shojaei et al, 2019), acute/severe sepsis (Ala-Kokko et al, 2016), systemic bloodstream infection (Moraes et al, 2015), ICU-AI (Ala-Kokko et al, 2016;Flynn et al, 2012;Kempker et al, 2015;Vosoughi et al, 2016), VAP (Flynn et al, 2012), and all-cause mortality (Alizadeh et al, 2015;Barnett et al, 2014;Cecchi et al, 2011;Kempker et al, 2015;Kvaran et al, 2016;Ratzinger et al, 2017;Vassiliou et al, 2018;Vosoughi et al, 2016) in critically ill patients. Likewise, researchers have reported that length of stay was (Alizadeh et al, 2015;Amrein et al, 2014;Ardehali et al, 2018;Ebenezer et al, 2016)…”

Section: Discussionmentioning

confidence: 99%

“…It plays an important role in modulating immune, endothelial, cardiovascular, and neurologic functions (Adams & Hewison, 2010). Vit D deficiency is highly prevalent in ICU patients (Alizadeh et al, 2015;Amrein et al, 2014;Ardehali et al, 2018;Kvaran et al, 2016;Lucidarme et al, 2010;Quraishi et al, 2014;Shojaei et al, 2019;Vassiliou et al, 2018). Holick (2007) reported that it was associated with cardiovascular, pulmonary, and infectious diseases and increased risk of mortality, which are common in ICU patients.…”

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confidence: 99%

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Plasma 25-Hydroxyvitamin D Level at Admission Predicts Unfavorable Outcome in Intensive Care Unit Patients

Maamer

Trifi

Fradj

et al. 2020

Biological Research For Nursing

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Introduction: Patients in intensive care units (ICUs) are at high risk of unfavorable outcomes. Considering the role of vitamin D (Vit D) in cardiovascular and immune functions, Vit D deficiency could affect ICU patients’ outcomes. This study aimed to evaluate Vit D status and its predictive value for outcome in ICU patients. Patients and Methods: A total of 169 ICU patients were followed during ICU stay. Primary outcome was the occurrence of at least one major adverse event; secondary outcomes were organ failure, septic shock, ICU-acquired infection, other adverse events, and ICU mortality. Plasma 25-hydroxyvitamin D (25(OH)D) was assessed by immunoassay. Multivariate Cox regression analyses were performed to test the associations of low 25(OH)D levels with poor outcomes. Results: Around 75% of patients had 25(OH)D levels <12 ng/ml. During their ICU stay, 114 patients experienced a major adverse event, 85 patients presented an ICU-acquired infection, and 22 patients died. Plasma 25(OH)D levels <12 ng/ml were associated with higher risk of major adverse events, Hazard ratio [95% CI], 4.47 [1.77, 11.3], p = .020, and ICU-acquired infection, 2.67 [1.01, 7.42], p = .049, but not with increased risk of ICU mortality. Conclusions: Hypovitaminosis D is very common in ICU patients. Results of the present study show that low plasma 25(OH)D levels are associated with increased risk of unfavorable outcomes in these patients. Additional research is needed to investigate the impact of Vit D status and effect of Vit D supplementation in ICU patients.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Plasma 25-Hydroxyvitamin D Level at Admission Predicts Unfavorable Outcome in Intensive Care Unit Patients

Maamer

Trifi

Fradj

et al. 2020

Biological Research For Nursing

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“…A retrospective cohort study showed that 54% (65/121) of patients with severe sepsis or septic shock had vitamin D levels lower than 15 mg/mL 13 , and another prospective multicenter study demonstrated vitamin D deficiency in 78.8% (197/250) of patients 14 . Furthermore, several studies document that vitamin D deficiency could be associated with poor outcomes in critically ill patients 12,13,[15][16][17][18] . To improve the outcomes of critically ill patients, vitamin D supplementation was proposed for ICU patients.…”

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confidence: 99%

Vitamin D supplementation and the outcomes of critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials

Lan

Lai

Chang³

et al. 2020

Sci Rep

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this meta-analysis assessed the association between vitamin D supplementation and the outcomes of critically ill adult patients. A literature search was conducted using the PubMed, Web of Science, EBSCO, Cochrane Library, Ovid MEDLINE, and Embase databases until March 21, 2020. We only included randomized controlled trials (RCTs) comparing the efficacy of vitamin D supplementation with placebo in critically ill adult patients. The primary outcome was their 28-day mortality. Overall, 9 RCTs with 1867 patients were included. In the pooled analysis of the 9 RCTs, no significant difference was observed in 28-day mortality between the vitamin D supplementation and placebo groups (20.4% vs 21.7%, OR, 0.73; 95% CI, 0.46-1.15; I 2 = 51%). This result did not change as per the method of vitamin D supplementation (enteral route only: 19.9% vs 18.2%, OR, 1.19; 95% CI, 0.88-1.57; I 2 = 10%; intramuscular or intravenous injection route: 25.6% vs 40.8%, OR, 0.48; 95% CI, 0.21-1.06; I 2 = 19%) or daily dose (high dose: 20.9% vs 19.8%, OR, 0.83; 95% CI, 0.51-1.36; I 2 = 53%; low dose: 15.6% vs 21.3%, OR, 0.74; 95% CI, 0.32-1.68; I 2 = 0%). No significant difference was observed between the vitamin D supplementation and placebo groups regarding the length of ICU stay (standard mean difference [SMD], − 0.30; 95% CI, − 0.61 to 0.01; I 2 = 60%), length of hospital stay (SMD, − 0.17; 95% CI, − 041 to 0.08; I 2 = 65%), and duration of mechanical ventilation (SMD, − 0.41; 95% CI, − 081 to 0.00; I 2 = 72%). In conclusion, this meta-analysis suggested that the administration of vitamin D did not provide additional advantages over placebo for critically ill patients. However, additional studies are needed to confirm our findings. Vitamin D, a fat-soluble vitamin, is an essential nutrient in bone metabolism and calcium and phosphorus homeostasis. However, the system of vitamin D is complex, in which some novel pathways have been found for host response to vitamin D treatment including non-canonical pathways of vitamin D activation 1,2 leading to production of non-or low-calcemic analogs 3 and of lumisterol activation 4. In clinical practice, vitamin D is used for the treatment of hyperproliferative skin diseases, hyperparathyroidism, and osteoporosis. Vitamin D also exhibits other non-skeletal pleiotropic properties, such as immunomodulatory, antimicrobial, cardiovascular, and muscular effects. Therefore, vitamin D deficiency is associated with many diseases including tuberculosis, nonalcoholic fatty liver disease, cardiovascular disease, and metabolic syndrome 5-7. In the United States, adults aged 20-39 years are at the highest risk of vitamin D deficiency

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“…Aging decreases the ability of the skin to synthesize vitamin D, and increased skin pigmentation reduces the efficacy of UV-B to stimulate synthesis of vitamin D ( 14 , 15 ). It is well known that individuals living farther from the equator have lower vitamin D status ( 13 , 16 ), and concentrations are lower in individuals with darker skin pigmentation ( 15 ). The prevalence of vitamin D deficiency is highest in the elderly (61%) ( 17 ), the obese (35% higher than in nonobese) ( 18 ), nursing home residents (50–60% of nursing home and hospitalized patients) ( 13 ), and those with higher melanin in their skin (40%) ( 19 ).…”

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confidence: 99%

Vitamin D and COVID-19: Lessons from Spaceflight Analogs

Zwart

Smith

2020

The Journal of Nutrition

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Severe vitamin D deficiency is common in critically ill patients at a high northern latitude

Cited by 7 publications

References 36 publications

Plasma 25-Hydroxyvitamin D Level at Admission Predicts Unfavorable Outcome in Intensive Care Unit Patients

Plasma 25-Hydroxyvitamin D Level at Admission Predicts Unfavorable Outcome in Intensive Care Unit Patients

Vitamin D supplementation and the outcomes of critically ill adult patients: a systematic review and meta-analysis of randomized controlled trials

Vitamin D and COVID-19: Lessons from Spaceflight Analogs

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