Korean J Crit Care Med.  2016 Nov;31(4):300-307. 10.4266/kjccm.2016.00276.

Prevalence and Related Factors of Vitamin D Deficiency in Critically Ill Patients

• Kim HJ
• Sohn MS
• Choi EY

• KMID: 2371185
• DOI: http://doi.org/10.4266/kjccm.2016.00276

Abstract

BACKGROUND
To identify the prevalence and related factors for vitamin D deficiency in the patients who admitted to the medical intensive care unit (ICU) of a Korean tertiary care hospital.
METHODS
We retrospectively analyzed the data from ICU patients requiring mechanical ventilation (MV) for a period of > 48 h to identify the prevalence and associated factors for vitamin D deficiency. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D [25(OH)D] level < 20 ng/mL.
RESULTS
Among 570 patients admitted to the ICU, 221 were enrolled in the study, 194 in the vitamin D deficient group and 27 in the non-deficient group. Prevalence of vitamin D deficiency in critically ill patients was 87.8%. The patient age was lower in the vitamin D deficient group compared with the non-deficient group (64.4 ± 15.4 vs. 71.0 ± 9.6 years, p = 0.049). A higher acute physiology and chronic health evaluation II (APACHE II) score (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.10-1.37) and chronic illness (OR 3.12, 95% CI 1.08-9.01) were associated with vitamin D deficiency after adjusting for age and body mass index. Clinical outcomes of duration of MV, ICU stay, and 28- and 90-day mortality rates were not significantly different between the vitamin D deficient and nondeficient groups.
CONCLUSIONS
Vitamin D deficiency was common in critically ill patients, particularly among younger patients. Higher APACHE II score and chronic illness were associated with vitamin D deficiency.

Keyword

25-hydroxyvitamin D; calcitriol; critical care; intensive care units; vitamin D deficiency

MeSH Terms

APACHE
Body Mass Index
Calcitriol
Chronic Disease
Critical Care
Critical Illness*
Humans
Intensive Care Units
Mortality
Prevalence*
Respiration, Artificial
Retrospective Studies
Tertiary Healthcare
Vitamin D Deficiency*
Vitamin D*
Vitamins*
Calcitriol
Vitamin D
Vitamins

Figure

• 

  Fig. 1. Flow chart of enrolled patients in this study. ICU: intensive care unit; MV: mechanical ventilator; 25(OH)D: 25-hydroxyvitamin D.

Reference

References

1. Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr. 2012; 36:713–20.

2. Arnson Y, Gringauz I, Itzhaky D, Amital H. Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients. QJM. 2012; 105:633–9.

3. Rech MA, Hunsaker T, Rodriguez J. Deficiency in 25-hydroxyvitamin D and 30-day mortality in patients with severe sepsis and septic shock. Am J Crit Care. 2014; 23:e72–9.

4. Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK. 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. Am J Surg. 2012; 204:37–43.

5. Quraishi SA, McCarthy C, Blum L, Cobb JP, Camargo CA Jr. Plasma 25-hydroxyvitamin D levels at initiation of care and duration of mechanical ventilation in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2016; 40:273–8.

6. Verceles AC, Weiler B, Koldobskiy D, Goldberg AP, Netzer G, Sorkin JD. Association between vitamin D status and weaning from prolonged mechanical ventilation in survivors of critical illness. Respir Care. 2015; 60:1033–9.

7. Holick MF. Vitamin D Deficiency. N Engl J Med. 2007; 357:266–81.

8. Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol. 2008; 8:685–98.

9. Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, et al. Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab. 2008; 93:3927–35.

10. Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004; 79:820–5.

11. Schöttker B, Haug U, Schomburg L, Köhrle J, Perna L, Müller H, et al. Strong associations of 25-hydroxyvitamin D concentrations with all-cause, cardiovascular, cancer, and respiratory disease mortality in a large cohort study. Am J Clin Nutr. 2013; 97:782–93.

12. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011; 96:53–8.

13. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96:1911–30.

14. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab. 2011; 96:643–51.

15. Vieth R, Cole DE, Hawker GA, Trang HM, Rubin LA. Wintertime vitamin D insufficiency is common in young Canadian women, and their vitamin D intake does not prevent it. Eur J Clin Nutr. 2001; 55:1091–7.

16. Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet. 1982; 319:74–6.

17. Greene-Finestone LS, Berger C, de Groh M, Hanley DA, Hidiroglou N, Sarafin K, et al. 25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates. Osteoporos Int. 2011; 22:1389–99.

18. MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest. 1985; 76:1536–8.

19. Jhun BW, Kim SJ, Kim K, Lee JE, Hong DJ. Vitamin D status in South Korean military personnel with acute eosinophilic pneumonia: a pilot study. Tuberc Respir Dis (Seoul). 2015; 78:232–8.

20. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000; 72:690–3.

21. Lucidarme O, Messai E, Mazzoni T, Arcade M, du Cheyron D. Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med. 2010; 36:1609–11.

22. Lee P, Eisman JA, Center JR. Vitamin D deficiency in critically ill patients. N Engl J Med. 2009; 360:1912–4.

23. Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab. 2011; 25:769–81.

24. Pittas AG, Laskowski U, Kos L, Saltzman E. Role of vitamin D in adults requiring nutrition support. JPEN J Parenter Enteral Nutr. 2010; 34:70–8.

25. Thadhani R, Appelbaum E, Pritchett Y, Chang Y, Wenger J, Tamez H, et al. Vitamin D therapy and cardiac structure and function in patients with chronic kidney disease: the PRIMO randomized controlled trial. JAMA. 2012; 307:674–84.

26. Nair P, Venkatesh B, Lee P, Kerr S, Hoechter DJ, Dimeski G, et al. A randomized study of a single dose of intramuscular cholecalciferol in critically ill adults. Crit Care Med. 2015; 43:2313–20.

27. Amrein K, Schnedl C, Holl A, Riedl R, Christopher K, Pachler C, et al. Effect of high-dose vitamin d3 on hospital length of stay in critically ill patients with vitamin d deficiency: the VITdAL-ICU randomized clinical trial. JAMA. 2014; 312:1520–30.

28. Manaseki-Holland S, Maroof Z, Bruce J, Mughal MZ, Masher MI, Bhutta ZA, et al. Effect on the incidence of pneumonia of vitamin D supplementation by quarterly bolus dose to infants in Kabul: a randomised controlled superiority trial. Lancet. 2012; 379:1419–27.

29. Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, et al. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011; 15:R104.

30. Mata-Granados J, Vargas-Vasserot J, Ferreiro-Vera C, Luque de Castro ML, Pavón RG, Quesada Gó- mez JM. Evaluation of vitamin D endocrine system (VDES) status and response to treatment of patients in intensive care units (ICUs) using an on-line SPELC-MS/MS method. J Steroid Biochem Mol Biol. 2010; 121:452–5.