A Review of Vitamin D Deficiency in the Critical Care Population

Abstract

It is well documented that a large percentage of the general population is either vitamin D insufficient or deficient. Vitamin D deficiency adversely affects bone health. More recently, it has been reported that vitamin D is an important component in immune function and glycemic control Substantial data exist that demonstrate an association between vitamin D insufficiency/deficiency and mortality/clinical outcomes of critically ill patients. The larger clinical trials addressing this association have demonstrated an increased odds ratio for mortality in both vitamin D insufficient and deficient patients when compared to those with sufficient vitamin D. There is also some evidence that vitamin D status worsens during critical illness without supplementation of this vitamin. Supplementation of vitamin D during critical illness of patients with vitamin D deficiency has been studied, but not in great detail. Daily supplementation of the recommended dietary allowance (RDA) of vitamin D does very little to improve the 25(OH)D serum concentrations in the critically ill patients with vitamin D insufficiency or deficiency. There is some evidence that high-dose therapy of vitamin D improves the depressed serum concentrations of this vitamin; however, there are no clinical outcome data available yet. The association between vitamin D insufficiency or deficiency and clinical outcome in the critically ill appears to be important. Supplementation of vitamin D will increase the serum concentrations of this vitamin; however the optimal dose needs to be identified along with an assessment of clinical outcome.

Prognostic Relevance of Circulating 25OHD Fractions for Early Recovery and Survival in Patients with Hip Fracture

“…According to Folman et al [ 9 ], only 16.7% of institutionalized elderly patients with femoral neck fractures regained their overall functional ability after surgical treatment, and only in 12.9% of them returned to their pre-injury, ambulatory status. Sufficient VD status plays important roles in both fracture prevention and post-surgical recovery, because it improves muscle strength and improves quality of life during healing, while also reducing the risks for chronic diseases such as diabetes, cancer, osteoporosis and cardiovascular events [ 10 , 11 , 12 , 13 ]. Nevertheless, the relation between VD status and healing after hip fractures had not been sufficiently addressed [ 14 , 15 , 16 , 17 ].…”

Association of vitamin D deficiency with clinical outcomes in critically ill Korean children

“…The pathophysiology and causes of VDD are probably multifactorial and quite complex. Previously reported risk factors for VDD include breastfed infants, living at high altitudes because of limited UV light exposure, dark skin and a high BMI due to a supposed sequestration of dietary vitamin D in the adipose tissue [2,24]. In addition, the prevalence of VDD can vary by geographical location, ethnicity, dietary habit, body composition and by different combinations of clinical comorbidities [23].…”

“…Vitamin D is well known pleiotropic prohormone that plays a key role in various pathophysiologic processes and has multiple actions on various target tissues and organs in the human body. Apart from its primary influences on calcium homeostasis and bone metabolism that are required to maintain skeletal health, vitamin D also has an essential role in controlling cell differentiation, apoptosis and growth, and inflammatory, immunomodulatory and anticoagulant effects [1][2][3][4][5][6]. It thus shows associations with several clinical conditions including cardiovascular, renal, neuropsychological, infectious, immunologic, allergic, cardio-metabolic and malignant diseases [7][8][9][10][11][12].…”

“…There have therefore been various studies on the association between a low vitamin D level and the severity of critical illnesses on patient admission, intensive care unit (ICU) morbidity, mortality, and the outcomes of therapeutic trials. However, the findings of prior studies of vitamin D conducted in critically ill children remain controversial [2,3,[13][14][15][16][17][18][19][20]. Furthermore, there are currently no data on vitamin D in relation to in critically ill Korean children.…”

“…Median and range (all such values)2) Mean ± SD (all such values) M, male; F, female; PICU, pediatric intensive care unit; n, number; MV, mechanical ventilation; WBC, white blood cell; Hg, hemoglobin; CRP, C-reactive peptide; tBi, total bilirubin; PT, prothrombin time; ATIII, anti-thrombin; CRP, C-reactive peptide; RDW, red blood cell distribution width; ISTH DIC score, international society on Thrombosis and Hemostasis Disseminated intravascular coagulation score; PRISM III, pediatric risk of mortality; pSOFA, pediatric sequential organ failure assessment; pMODS, pediatric multiple organ dysfunction syndrome.…”