Vitamin D Deficiency in Critically Ill Patients

Lee, Paul; Eisman, John A.; Center, Jacqueline R

doi:10.1056/nejmc0809996

Cited by 233 publications

(133 citation statements)

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“…The well-known major function of vitamin D is to maintain calcium and phosphorus homeostasis and bone mineralization, but currently, many studies have focused on the novel roles of vitamin D in glucose metabolism, endothelial functions and immune modulation (Nierman and Mechanick 1998;Grant 2009;Lee et al 2009;Braun et al 2011). Although the mechanism of vitamin D on enhanced immunity is complex, it might have an important role in the optimal function of the innate immune system by inducing antimicrobial peptides in epithelial cells, neutrophils and macrophages (Kempker et al 2012;Clancy et al 2013).…”

Section: Introductionmentioning

confidence: 99%

High Serum 25-Hydroxyvitamin D Levels Are Associated with Pediatric Sepsis

Aydemir¹,

Çekmez²,

Kalkan

et al. 2014

Tohoku J. Exp. Med.

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Despite major advances in intensive care, sepsis continues to be a major cause of morbidity and mortality. Vitamin D is involved in various physiologic functions, including cellular responses during infection and inflammation. The aim of this study was to evaluate diagnostic value of 25-hydroxyvitamin D in childhood sepsis because it can be fatal if diagnosis delayed. The study included 40 children with sepsis and 20 children without sepsis (control group). We included only the patients with high probable sepsis, judged by clinical and laboratory findings, including positive blood culture. Blood samples were collected from patients with sepsis before treatment (pre-treatment group) and 48-72 hours later (post-treatment group). Treatment varied from ampicillin-sulbactam to cephalosporin. Blood samples were collected from control group once on admission. Serum 25-hydroxyvitamin D levels were significantly higher in sepsis (pre-treatment group) than control group (74 ± 8 ng/ml vs. 28 ± 12 ng/ml, p = 0.01) and the serum 25-hydroxyvitamin D levels were decreased to 44 ± 5 ng/ml (p = 0.01) after treatment. Moreover, we found significant positive correlation between 25-hydroxyvitamin D and each of well-know sepsis markers, C-reactive protein, tumor necrosis factor-α and interleukin-6. A cut-off point of 20 ng/mL for serum 25-hydroxyvitamin D showed 84% sensitivity and 76% specificity for sepsis diagnosis. This is the first study evaluating the diagnostic role of vitamin D in pediatric sepsis, thereby suggesting that serum 25-hydroxyvitamin D level can be used as a diagnostic marker for sepsis with high sensitivity and specificity.

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Section: Introductionmentioning

confidence: 99%

High Serum 25-Hydroxyvitamin D Levels Are Associated with Pediatric Sepsis

Aydemir¹,

Çekmez²,

Kalkan

et al. 2014

Tohoku J. Exp. Med.

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“…Vitamin D deficiency (serum level of 25-hydroxyvitamin D ≤ 15 ng/mL; to convert to nanomoles per liter, multiply by 2.496) has been reported in 27% to 50% of intensive care unit (ICU) patients, and vitamin D insufficiency (15-30 ng/mL) has been reported in 38% of critically ill patients. 14,15 In a small cohort of ICU patients, 17% had undetectable levels of vitamin D. 16 In 2 recent studies, 14,15 a serum level of 25-hydroxyvitamin D less than 15 ng/mL in the year preceding hospital admission and within 7 days of ICU admission was independently associated with increased mortality. Furthermore, these studies indicated that 25-hydroxyvitamin D deficiency (defined as a serum level <15 ng/mL) before hospital admission was a significant predictor of sepsis in the critically ill, and patients with sepsis whose 25-hydroxyvitamin D level before admission was less than 30 ng/mL had increased risk for mortality after the ICU admission.…”

mentioning

confidence: 99%

Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

Rech

Hunsaker

Rodriguez

2014

American Journal of Critical Care

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Background Vitamin D has immunomodulating properties. Objective To determine if vitamin D deficiency within 30 days of admission to the intensive care unit in patients with sepsis might be associated with increased all-cause 30-day mortality. Methods In a retrospective cohort study at a large, tertiary, urban, academic medical center, records of patients who had 25-hydroxyvitamin D levels measured within 30 days of admission for severe sepsis or septic shock from June 2006 to April 2011 were examined. Patients were considered deficient in vitamin D if its serum concentration was 15 ng/mL or less. The primary outcome of interest was 30-day mortality. Results Among the 121 patients in the sample, 65 (54%) were vitamin D deficient. Baseline demographics were similar between vitamin D deficient and nondeficient groups, except that the vitamin D deficient group had more African Americans (P = .01). All-cause 30-day mortality was significantly higher in patients deficient in vitamin D (37% vs 20%; P = .04) and remained higher at 90 days (51% vs 25%, P = .005). In multivariate analysis, age (odds ratio, 1.04; 95% CI 1.01–1.07; P = .01) and vitamin D deficiency (odds ratio, 2.7; 95% CI, 1.39–18.8; P = .02) were independently associated with increased 30-day mortality. Conclusion Patients deficient in vitamin D within 30 days of hospital admission for severe sepsis or septic shock may be at increased risk for all-cause 30-day mortality.

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“…40 ng/mL may be also justified, as at this level maximum function of 25-hydroxylase appears to be achieved (Hollis et al, 2007). In addition, in a study of dialysis patients no patient with 25(OH)D > 40 ng/mL had radiological evidence of subperiosteal resorption (Ghazali et al, 1999 (Lips et al, 2006;Lee et al, 2009;LaClair et al, 2005;Jean et al, 2008;Lips, 2007). There were also publications revealing suboptimal vitamin D status of patients after successful kidney transplantation.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Vitamin D Deficiency Among Patients After Kidney Transplantation in Latvia

Adamsone¹,

Folkmane²,

Amerika³

et al. 2013

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences

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Contributed by Rafails Rozentâls Nutritional Vitamin D deficiency is an increasingly recognised condition in chronic kidney 49.7 years (range: 11-80). Median time after transplantation was 6.5 years (range 0.8-16.4 years). Mean 25(OH)D level for all cohort was 22.71 ± 7.06 ng/mL; only 30/165 (18%) of patients were vitamin D sufficient. 71/165 (43%) patients showed insufficient 25(OH)D level, 62/165 (38%) patients were mildly vitamin D deficient, and 2/165 (1%) were severely vitamin D deficient. Serum creatinine level was negatively correlated with 25(OH)D (r = -0.21; P < 0.01). We also observed an inverse correlation between iPTH and 25(OH) D (r = -

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Vitamin D Deficiency in Critically Ill Patients

Cited by 233 publications

References 4 publications

High Serum 25-Hydroxyvitamin D Levels Are Associated with Pediatric Sepsis

High Serum 25-Hydroxyvitamin D Levels Are Associated with Pediatric Sepsis

Deficiency in 25-Hydroxyvitamin D and 30-Day Mortality in Patients With Severe Sepsis and Septic Shock

Prevalence of Vitamin D Deficiency Among Patients After Kidney Transplantation in Latvia

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