Prevalence of Vitamin Deficiencies on Admission: Relationship to Hospital Mortality in Critically Ill Patients

Abstract

Optimal nutritional support, both in terms of route and formulation, in the critically ill remains controversial 1,2 . Apart from ensuring adequate caloric and protein intake, supplementation of micronutrients such as omega-3 fatty acids, glutamine, selenium and antioxidant vitamins has also been suggested to be important 3,4 . The rationale behind such practice is based on observational data in the critically ill.Oxidant stress is radically increased in critical illness and antioxidant capacity is consumed 5 .Circulatory antioxidant deficiency appears to be common in high acuity illnesses 6,7 and may contribute to patient mortality [8][9][10] . Serum concentrations of antioxidant vitamins are often transiently depressed as part of the acute phase response in critical illness 11,12 , particularly Vitamins A and E, whose concentrations are almost unrecordable in septic shock 5 and burns >20% of body surface area 13 . Major fluid shifts, diarrhoea, dialysis, diuresis and burn exudates contribute to substantial losses of watersoluble vitamins and trace elements 8 . Older studies suggested that deficiencies of the B vitamins were associated with complications and poor outcome in patients with critical illness 14,15 .While it may seem intuitive to supplement vitamins in all critically ill patients, the results of studies assessing the effects of antioxidant supplementation remain inconsistent 16 . Although studies employing supplementation of these vitamins have confirmed increases in plasma concentrations 9,10,17,18 , a consistent effect upon antioxidant defences 9 or outcome has not yet been convincingly demonstrated 10,18,19 . Furthermore, many of these studies did not measure the concentrations

General Adaptation in Critical Illness: Glucocorticoid Receptor-alpha Master Regulator of Homeostatic Corrections

“…In critical illness, the prevalence of thiamine deficiency is 10-20% upon admission (198,240) and can increase up to 71% during ICU stay, suggesting rapid depletion of this vitamin (198). Based on limited data, no association was detected between thiamine levels, markers of oxidative stress (198) and mortality (198,241). In one study, a significant negative correlation was reported between thiamine and lactic acid levels in patients with sepsis without liver dysfunction (240).…”

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

“…Critical care patients require more vitamin B12 and folic acid, which may lead to relative vitamin B12 and folic acid deficiency and subsequently tothrombocytopenia, megaloblastic anemia, and hyperhomocysteinemia [84]. Studies have shown that vitamin B12 or folic acid deficiency is associated with the severity of patient condition [85]. Folic acid deficiency may also occur during RRT [86].…”

High vitamin B12 levels are not associated with increased mortality risk for ICU patients after adjusting for liver function: A cohort study

“…Olivieri et al 14 conducted a study of 250 elderly patients with acute myocardial infarction admitted to a cardiac care unit (CCU) and found that vitamin B12 was not a significant predictor for cardiovascular-related mortality. Corcoran et al 15, 16 studied on the effect of vitamin B12 levels on mortality in the ICU and found that there was no association between B12 deficiency and mortality, and that weak correlations existed between B12 levels, CRP, and Sequential Organ Failure Assessment (SOFA) score, a measure of acuity in the ICU 17 . Manzanares and Hardy 18 conducted a review of studies on the relationship between B12 and mortality and noted that the data on B12 and mortality for critical care patients was scarce.…”