Vit D-ICU outcomes in veterans- J Am Med Dir Assoc-2011-ETSU

Relationship between vitamin d status and ICU outcomes in veterans.

J Am Med Dir Assoc. 2011 Mar;12(3):208-11.-McKinney JD, Bailey BA, Garrett LH, Peiris P, Manning T, Peiris AN.- Mountain Home VAMC, Mountain Home, TN;

ETSU Department of Internal Medicine, Johnson City, TN.

East Tennessee State University Link http://www.etsu.edu/com/intmed/endocrinology/research-vitamind-peiris.aspx

Key Points:

1.  Vitamin D deficient ICU patients are almost twice as likely to die. It didn’t matter the reason for the hospitalization and it didn’t matter whether the vitamin D level was drawn before or after the hospitalization.

2. The authors reviewed records of 136 veterans who were hospitalized in the intensive care unit and who happened to have a vitamin D blood level done a within a month of that hospitalization.

CONCLUSION: A vitamin D-replete state may reduce costs and confer survival advantages in critical illness. We recommend that 25(OH)D levels be routinely checked and deficiencies treated in ICU patients.

OBJECTIVE: Vitamin D deficiency remains a poorly recognized pandemic and is closely linked to increased health care costs in veterans. Projected health care needs in veterans are expected to increase over the next decade. Intensive care unit (ICU) costs contribute significantly to hospital costs and stem from intervention services and management of sepsis including nosocomial infections. Vitamin D has immunomodulating and antimicrobial properties through antimicrobial peptides such as cathelicidin.

DESIGN/METHODS: A retrospective study was undertaken to evaluate if vitamin D deficiency was associated with less than optimal ICU outcomes in veterans. The study included 136 veterans with 25(OH)D levels drawn within a month of admission to ICU.

RESULTS: The average 25(OH)D level was 24.6 ng/mL (normal range 30-100) with 38% of patients falling in the vitamin D-deficient category (<20 ng/mL). ICU survivors had a significantly lower rate of vitamin D deficiency compared with nonsurvivors (28% versus 53%).

Twenty-nine percent of vitamin D-replete patients were in ICU 3 days or more, whereas 58% of patients with vitamin D deficiency stayed in ICU 3 days or longer.

This difference was highly significant translating to twofold increased risk (2.0 Relative Risk RR) for 3-day or longer stay in ICU for patients with vitamin D deficiency. Moreover, the risk of death was significantly higher in ICU patients with vitamin D deficiency (RR 1.81).

Pub Med. Gov link http://www.ncbi.nlm.nih.gov/pubmed/21333923

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