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

Abstract

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.

Acute Respiratory Distress Syndrome; A Review of Recent Updates and a Glance into the Future

“…In 2022, a secondary analysis of the ALVEOLI study was carried out to explore the connection between vitamin D status and two outcomes: ventilator-free days and 90-day survival [89]. The study revealed that patients with vitamin D deficiency had a longer duration of mechanical ventilation and a greater likelihood of 90-day mortality.…”

The Role of Vitamin D in Supporting Health in the COVID-19 Era

“…Vitamin D status was also associated with the duration of mechanical ventilation and mortality in patients admitted with ARDS. Data analysis of a randomized, controlled trial from the ALVEOLI study revealed that severe vitamin D deficiency was common in patients with ARDS [ 140 ]. In fact, patients with 25(OH)D3 < 10 ng/mL were likely to be ventilated for nine days longer than patients with levels >10 ng/mL and showed a higher risk of 90-day mortality [ 140 ].…”

“…The advantage of calcidiol administration was reported in osteoporotic patients [ 160 ]. Furthermore, the best route of administration and early treatment must be considered, taking into account the clinical characteristics of the patients, baseline 25(OH)D3 levels, and outcome measurement [ 140 , 161 ]. Although some studies considered serum 25(OH)D3 as a negative acute-phase reactant [ 162 ], nonetheless, supplementation with the hormone was found to be generally helpful in COVID-19 outcomes.…”