The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery

Turan, Alparslan; Hesler, Brian D.; You, Jing; Saager, Leif; Grady, Martin; Komatsu, Ryu; Kurz, Andrea; Sessler, Daniel I.

doi:10.1213/ane.0000000000000096

Cited by 23 publications

(25 citation statements)

References 30 publications

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“…These are questions stimulated by the elegant report using sophisticated statistical analyses from Outcome Researchers in the Anesthesiology Institute at Cleveland Clinic. 2 They conclude: While causality cannot be determined from our retrospective analysis, the association suggests that a large prospective observational study of preoperative vitamin D concentrations and postoperative outcomes is warranted.…”

Section: Don't Be Wimpymentioning

confidence: 88%

“…The association vitamin D study of Turan et al 2 continues a long series of association studies. Similar to other association studies, this study is bedeviled by the following problems: (a) there may be selection bias (i.e., it is not clear why vitamin Ds were obtained in these patients); (b) the population examined is a heterogeneous one, in that vitamin Ds were obtained at different times (though this drawback is also a strength in that, it shows the association is true regardless of the time of sampling, and so may not simply be an effect due to postoperative inflammation); and (c) the group with low vitamin D also had worse preoperative ASA physical status classification.…”

Section: Enough Association Studiesmentioning

confidence: 96%

“…If we were to devise a DBRCT with limited funds, we would enroll patients with D levels under a certain number (probably 13.7 based on Turan et al 2 ), undergoing operations with measurable complication risks. We would enroll enough people to power the study so that a 10 ng/mL increase in 25-OHD levels would reveal a decrease in complication rates of 10% (based on Turan et al 2 ).…”

Section: How Much D To Give and To Takementioning

confidence: 99%

“…We would enroll enough people to power the study so that a 10 ng/mL increase in 25-OHD levels would reveal a decrease in complication rates of 10% (based on Turan et al 2 ). We would enroll patients who were undergoing operations 18 to 24 days from their preoperative visit.…”

Section: How Much D To Give and To Takementioning

confidence: 99%

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Vitamin D and Your Patients

Roizen

Roizen²

2014

Anesthesia &Amp; Analgesia

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Section: Don't Be Wimpymentioning

confidence: 88%

Section: Enough Association Studiesmentioning

confidence: 96%

Section: How Much D To Give and To Takementioning

confidence: 99%

Section: How Much D To Give and To Takementioning

confidence: 99%

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Vitamin D and Your Patients

Roizen

Roizen²

2014

Anesthesia &Amp; Analgesia

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“…9 As such, 25-OH vitamin D could still be valuable as a clinical prognostic marker. 8,[10][11][12] While several clinical studies have evaluated the association between 25-OH vitamin D and risk of CVD outcomes, complications, and mortality following surgery or hospitalization, [13][14][15][16][17][18][19][20] few have fully evaluated the prognostic value of 25-OH vitamin D by contrasting model discrimination, fit, and calibration to those from models containing established risk factors. Furthermore, none have examined the ability of 25-OH vitamin D to appropriately reclassify patient risk when added to models containing established risk factors.…”

mentioning

confidence: 99%

Serum Total 25‐OH Vitamin D Adds Little Prognostic Value in Patients Undergoing Coronary Catheterization

Gerling

James

Wilton

et al. 2016

JAHA

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BackgroundVitamin D deficiency is associated with an increased risk of cardiovascular disease; however, it is unclear whether vitamin D status should be considered in clinical risk assessments of patients with cardiovascular disease.Methods and ResultsThis study included 2975 patients who had their first serum total 25‐hydroxy vitamin D (25‐OH vitamin D) measurement before their first coronary catheterization in Alberta, Canada. Cox regression was used to examine associations between 25‐OH vitamin D and mortality risk after adjusting for demographic and clinical risk factors. Interactions were tested using multiplicative terms, and prognostic value was assessed using measures of model discrimination, fit, calibration and net reclassification improvement. There were 401 deaths over a median of 5.8 years of follow‐up. Serum total 25‐OH vitamin D was inversely associated with mortality after adjusting for demographic and clinical risk factors, which was largely driven by excess risk in the bottom quintile (hazard ratio 1.84 for bottom versus top quintile, 95% CI 1.36–2.50, P for trend <0.001). Associations were weaker in the presence of several competing risk factors (e.g., advanced age; P for interactions <0.05). Adding 25‐OH vitamin D to a model containing demographic and clinical risk factors yielded similar discrimination, model fit, and calibration and only modest improvements in risk reclassification (net reclassification improvement 1.9% for deaths, 2.3% for survivors).ConclusionsPre‐catheterization, serum total 25‐OH vitamin D was inversely associated with mortality risk after adjusting for established demographic and clinical risk factors. This association was attenuated by several competing risk factors. Overall, 25‐OH vitamin D added little prognostic value over established risk factors; therefore, its measurement is not warranted in patients undergoing coronary catheterization.

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Vitamin D as Cancer Therapy?

Barry

Passarelli

Baron

2019

JAMA

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Over the past 30 years, extensive research has explored the use of nutritional supplements for prevention of cancer. Despite what appears to be strong observational evidence, randomized clinical trials of beta carotene, ascorbic acid, alpha tocopherol, selenium, and folic acid all failed to show evidence of efficacy for cancer chemoprevention. 1,2 The colorectum has been particularly well studied: trials of these interventions examining adenoma recurrence have been uniformly negative as well. 3,4 The latest supplement of interest is vitamin D. Observational studies have consistently found that high vitamin D status, as measured by circulating 25-hydroxyvitamin D (25[OH]D) is inversely related to the risk of colorectal cancer. 5 However, high 25(OH)D levels may be a marker of "good health," a trait that observational studies may not be able to fully control for in analysis. Two recent clinical trials failed to find a chemopreventive benefit of vitamin D 3 supplementation. In the VITAL trial, 2000 IU/d for a median of 5.3 years did not reduce risk of all cancer or colorectal cancer. 6 This may have been due to the short follow-up in the context of the long latent period for carcinogenesis. In another trial reported in 2015, 1000 IU/d of vitamin D 3 for 3 to 5 years did not reduce adenoma recurrence, and although the follow-up period was sufficient to assess this risk, the dosage of vitamin D in that trial may have been too low. 7 A separate but related issue is whether vitamin D supplementation could be used to improve outcomes in patients with cancer. In this issue of JAMA, the first clinical trials of vitamin D 3 supplementation in patients with advanced or metastatic colorectal cancer (the SUNSHINE trial) 8 or luminal gastrointestinal cancer (the AMATERASU trial) 9 are reported. There are data motivating these trials. A meta-analysis reported a statistically significant association between higher 25(OH)D concentrations measured at or near the time of cancer diagnosis and reduced overall and cancer-specific mortality, including colorectal cancer. 10 However, there are few data suggesting similar associations for cancers of the stomach and esophagus.The SUNSHINE phase 2 trial conducted in North America investigated oral supplementation with vitamin D 3 added to standard chemotherapy in 139 patients with unresectable advanced or metastatic colorectal cancer, and compared highdose vitamin D 3 (8000 IU/d for 2 weeks and 4000 IU/d thereafter) with standard-dose vitamin D 3 (400 IU/d). 8 Participants randomized to receive high-dose vitamin D 3 experienced

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The Association of Serum Vitamin D Concentration with Serious Complications After Noncardiac Surgery

Cited by 23 publications

References 30 publications

Vitamin D and Your Patients

Vitamin D and Your Patients

Serum Total 25‐OH Vitamin D Adds Little Prognostic Value in Patients Undergoing Coronary Catheterization

Vitamin D as Cancer Therapy?

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