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  • Poster presentation
  • Open Access

High prevalence of severe vitamin D deficiency in intensive care patients

  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
Critical Care201014 (Suppl 1) :P588

https://doi.org/10.1186/cc8820

  • Published:

Keywords

  • Pleiotropic Effect
  • Enteral Feeding
  • Standardize Mortality Ratio
  • Observational Cohort Study
  • Intensive Care Patient

Introduction

Vitamin D deficiency seems increasingly prevalent in the community, and deficiency has been reported in almost 60% of medical inpatients [1]. Pleiotropic effects of vitamin D like immunomodulation and effects on muscle strength may be of special importance to critically ill patients. Despite this knowledge, vitamin D deficiency has only been studied in small and selected groups of ICU patients [2]. Therefore, we prospectively determined the prevalence of vitamin D deficiency and related vitamin D status to outcome in a cohort of critically ill patients.

Methods

This prospective observational cohort study was performed in a 20-bed general ICU of a teaching hospital in the city of Amsterdam between 1 March and 30 April 2009. We measured 25-hydroxyvitamin D (25-OH-D) on admission and after 48 hours in all consecutive patients admitted to our unit. Patients received enteral feeding. Additional vitamin D was not supplied. Vitamin D status was defined as: adequate: >75 nmol/l, insufficient: 50 to 75 nmol/l, deficient: 25 to 50 nmol/l, severely deficient: <25 nmol/l, undetectable: <10 nmol (to convert values for 25-OH-D to ng/ml, divide by 2.50). We compared observed and predicted mortality (APACHE IV), and standardized mortality ratio (SMR, observed/predicted number of nonsurvivors) between vitamin D cohorts.

Results

Vitamin D was measured in 111 patients at admission and in 44 after 48 hours. Mean 25-OH-D at admission was 31 nmol/l. Thirteen percent of the patients had undetectable 25-OH-D levels, 49% was severely deficient and 85% had a vitamin D <50 nmol/l. Only two patients had an adequate 25-OH-D status. During the first 48 hours of ICU admission, vitamin D decreased in 24 of 44 patients. Mean change was -2.3 nmol/l (range -32.5 to +22.5 nmol/l). Observed mortality was significantly lower than predicted in all patients (P = 0.02) and in patients with 25-OH-D >25 nmol/l (P = 0.04), but not in those <25 nmol/l (P = 0.21). See Table 1.
 

Number of patients

Age (years)

Hospital mortality (%)

APACHE IV p.m. (fraction)

SMR (fraction)

All patients

111

67

19

0.31

0.61 (0.38 to 0.93a)

25-OH-D <25 nmol/l

54

68

24*

0.34

0.71 (0.38 to 1.21a)

25-OH-D >25 nmol/l

57

67

14

0.29

0.48 (0.21 to 0.92a)

a95% confidence interval (Fischer's exact). *P = 0.33 compared with >25 nmol. p.m., predicted mortality.

Conclusions

At the end of winter, one-half of our patients had severe vitamin D deficiency. In contrast to patients with severe deficiency, the cohort with vitamin D levels more than 25 nmol/l had a significant lower mortality than predicted by APACHE IV score. Measurements from a larger patient cohort are collected to further analyze this finding.

Authors’ Affiliations

(1)
OLVG hHospital, Amsterdam, Netherlands

References

  1. Thomas MK, et al.: N Engl J Med. 1998, 338: 777-783. 10.1056/NEJM199803193381201PubMedView ArticleGoogle Scholar
  2. Lee P, et al.: N Engl J Med. 2009, 360: 1912-1914. 10.1056/NEJMc0809996PubMedView ArticleGoogle Scholar

Copyright

© BioMed Central Ltd. 2010

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