Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients

Abstract

BACKGROUND Vitamin D deficiency is the most common nutritional deficiency in the United States. It is seldom measured or recognized, and rarely is treated, particularly in critically ill patients. The purpose of this study was to investigate the prevalence and impact of vitamin D deficiency in surgical intensive care unit patients. We hypothesized that severe vitamin D deficiency increases the length of stay, mortality rate, and cost in critically ill patients admitted to surgical intensive care units. METHODS We performed a prospective observational study of vitamin D status on 258 consecutive patients admitted to the Surgical Intensive Care Unit at Grady Memorial Hospital between August 2009 and January 2010. Vitamin D levels (25 [OH]2 vitamin-D3) were measured by high-pressure liquid chromatography and tandem mass spectrometry. Vitamin D deficiency was defined as follows: severe deficiency was categorized as less than 13 ng/mL; moderate deficiency was categorized as 14 to 26 ng/mL; mild deficiency was categorized as 27 to 39 ng/mL; and normal levels were categorized as greater than 40 ng/mL. RESULTS Of the 258 patients evaluated, 70.2% (181) were men, and 29.8% (77) were women; 57.6% (148) were African American and 32.4% (109) were Caucasian. A total of 138 (53.5%) patients had severe vitamin D deficiency, 96 (37.2%) had moderate deficiency, 18 (7.0%) had mild deficiency, and 3 (1.2%) of the patients had normal vitamin D levels. The mean length of stay in the Surgical Intensive Care Unit for the severe vitamin D–deficient group was 13.33 ± 19.5 days versus 7.29 ± 15.3 days and 5.17 ± 6.5 days for the moderate and mild vitamin D-deficient groups, respectively, which was clinically significant (P = .002). The mean treatment cost during the patient stay in the surgical intensive care unit was $51,413.33 ± $75,123.00 for the severe vitamin D–deficient group, $28,123.65 ± $59,752.00 for the moderate group, and $20,414.11 ± $25,714.30 for the mild vitamin D–deficient group, which also was clinically significant (P = .027). More importantly, the mortality rate for the severe vitamin D–deficient group was 17 (12.3%) versus 11 (11.5%) in the moderate group (P = .125). Because no deaths occurred in the mildly or normal vitamin D–deficient groups, we compared the mortality rate between severe/moderate and mild/normal vitamin D groups (P = .047). CONCLUSIONS In univariate analysis, severe and moderate vitamin D deficiency was related inversely to the length of stay in the surgical intensive care unit (r = .194; P = .001), related inversely to surgical intensive care unit treatment cost (r = .194; P = .001) and mortality (r = .125; P = .023), compared with the mild vitamin D–deficient group, after adjusting for age, sex, race, and comorbidities (myocardial infarctions, acute renal failure, and pneumonia); the length of stay, surgical intensive care unit cost, and mortality remained significantly associated with vitamin D deficiency.

Vitamin D deficiency in the critically ill

“…This may result in even lower ''vitamin D levels'' as serum 25(OH)D is the accepted marker for vitamin D status. Several studies report low vitamin D levels to be a biomarker associated with sepsis severity, organ dysfunction and even mortality in critically ill patients (18)(19)(20)(21)(22)(23)(24).…”

Combination therapy with vitamin D3, progesterone, omega-3 fatty acids and glutamine reverses coma and improves clinical outcomes in patients with severe traumatic brain injuries: A case series

“…As both are very prevalent in the general US population and even more pronounced in critically ill patients with TBI, in our opinion, atrisk patients should be routinely supplemented with vitamin D and omega3 fatty acids. In fact, vitamin D levels less than 17.8 ng/mL is shown to be associated with a 28% increased allcauses risk of premature death [6]. Equally important, omega3 fatty acid deficiency is associated with over 96,000 preventable deaths in the US annually according to a recent report from the CDC.…”

“…Vitamin D (classified as a vitamin) is actually a steroid hormone with pleiotrophic effects, which includes its action as immune modulator [6]. Of note, receptors for vitamin D are located on every cell and tissue of the human body including brain tissue.…”

Serum Vitamin D Level at ICU Admission and Mortality

“…Several studies report that vitamin D deficiency in critically ill patients is associated with infection, the development of sepsis and acute respiratory distress syndrome (ARDS) and increased mortality rates (9,11,(14)(15)(16)(17)(18)(19)(20). Moromizato et al (21) found that serum vitamin D level below 16 ng mL -1 is associated with sepsis.…”