The relevance of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D concentration for postoperative infections and postoperative organ dysfunctions in cardiac surgery patients: The eVIDenCe study

Abstract

Background & aims: Recent studies indicate that vitamin D deficiency is associated with increased morbidity and mortality in critically ill patients. Knowledge about the functional role and clinical relevance of vitamin D for patients undergoing cardiac surgery is sparse. Therefore, we investigated the clinical significance of vitamin D levels on outcome of cardiac surgery patients. Methods: 92 patients undergoing elective cardiac surgery with cardiopulmonary arrest were included in this prospective observational pilot study. 25-hydroxyvitamin D (25OHD) and 1,25-dihydroxyvitamin D (1,25(OH) 2 D) levels were measured prior to surgery, immediately postoperatively as well as 6, 12 and 24 h after surgery. We assessed postoperative organ dysfunctions, infections and death until hospital discharge. Results: The serum concentration of 1,25(OH) 2 D significantly decreased intraoperatively by 29.3% (p < 0.001) and was significantly lower at any postoperative time point compared to baseline values, whereas 25OHD levels did not show significant changes during the observation period. Coronary artery bypass graft (CABG) patients had significant higher baseline 1,25(OH) 2 D values than patients with valve surgery (39.7 ± 13.9 ng/l vs. 30.1 ± 14.1 ng/l, p ¼ 0.010) or CABG þ valve surgery (39.7 ± 13.9 ng/l vs. 32.6 ± 11.8 ng/l, p ¼ 0.044). Our data showed a significant odds ratio to develop postoperative organ dysfunction (OR 0.95; p ¼ 0.009) and PCT levels !5 mg/l (OR 0.94; p ¼ 0.046) for every ng/l increment in 1,25(OH) 2 D, when performing multivariable analysis and after adjusting for preoperative illness and demographics. In addition, multivariable-adjusted statistical analyses revealed that patients stayed significantly shorter on ICU (À0.21 h; p ¼ 0.001) and in hospital (À2.6 days; p ¼ 0.009) for every ng/l increment in 1,25(OH) 2 D. Conclusion: Our data highlight important evidence about the clinical significance of 1,25(OH) 2 D levels in cardiac surgery patients. Higher levels were associated with significantly less postoperative organ dysfunctions, elevated PCT levels, death and prolonged hospital stay. 1,25(OH) 2 D levels decreased significantly intra-and postoperatively, while serum levels of 25OHD did not. Trial registration: clinicaltrials.gov (NCT 02488876), registered May 1, 2015.

Vitamin D Status and Pregnancy Complications: Serum 1,25-di-hydroxyl-Vitamin D and its Ratio to 25-hydroxy-Vitamin D are Superior Biomarkers than 25-hydroxy-Vitamin D

“…However, bigger multi-centric longitudinal and supplementation RCTs are strongly warranted to validate and generalize these assumptions. Several clinical outcomes, including infection, kidney function, diabetes and inflammation, were inversely correlated with circulating 1,25-diOH-VitD levels but not 25-OH-VitD 29 , 31 , 37 .…”

“…Therefore, the intracellular receptor supersaturating concentration is not required, albeit, for potential VDR-independent actions 34 . We resourced 1,25-diOH-VitD since several studies reported its superiority over 25-OH-VitD as an independent clinical correlate 31 , 35 - 37 . 25-OH-VitD is the local precursor and increases in its circulating levels parallel consequent increases in 1,25-diOH-VitD however, their relationship is not always straightforward 30 , 38 .…”

Vitamin D Treatment Attenuates Heart Apoptosis After Coronary Artery Bypass Surgery: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial

“…26,27 However, numerous studies indicated the association of vitamin D deficiency with increased major cardiovascular events, low cardiac output, and worse postsurgical outcomes in cardiac surgical patients. 25,[28][29][30][31] Although the involved mechanisms are not fully understood, vitamin D maintains mitochondrial function, attenuates inflammatory response, and prevents from caspase activation. 3,5,11 It may be due to a pharmacological effect, which was induced by intermittently high-dose vitamin D administration.…”

Effects of Oxidative Stress on Protein Translation: Implications for Cardiovascular Diseases

“…Antioxidant treatment strategies can be divided into three major categories, the first of which includes natural defense systems composed of vitamins: vitamin C (ascorbic acid), vitamin E (tocopherols), vitamin A (retinol, retinal, and retinoic acid), and vitamin D (secosteroids). Recent studies demonstrated a positive outcome of vitamin treatment of hypertension [187], cardiac hypertrophy [188], and post-operative complications after heart surgery [189]. In a large-scale populational study, antioxidant vitamins were administrated to 875 patients for 22 years; increased dietary intake of vitamins A, C, and E was associated with decreased incidents of adverse cardiovascular abnormalities [190].…”