Relationship between vitamin D levels and mortality rates of critically ill patients in intensive care unit

Year 2021, , 171 - 175, 24.04.2021

Müslüm Sağır , Mustafa Kaplan , Alpaslan Tanoğlu , Fevzi Demirel

https://doi.org/10.38053/acmj.901628

Cited By: 3

Abstract

Introduction: Vitamin D have a pivotal role in bone metabolism. It regulates immunity and inflammation. In this current research, it was aimed to determine whether there is an association between the mortality rate and the vitamin D level of critically ill patients who were followed in intensive care unit (ICU).
Material and Methods: Fifty two patients (30 (58%) female and 22 (42%) male) admitted to ICU with the diagnosis of respiratory failure, sepsis, acute renal failure, multiple organ failure, GIS bleeding were included in the study. During the admission to the ICU, all of the patients’ complete blood count, C-reactive protein, serum calcium, albumin, urea, creatinine, 25-OH vitamin D, potassium, and arterial/venous blood gas levels were measured. Their acceptable mortality risk was calculated according to the APACHE II scoring system.
Results: The level of vitamin D was found at least 1 up to 78.6 range, and the average was 19.61 ng/dl. Eighteen (35%) patients were discharged and 34 (65%) of the ICU patients were died. Vitamin D deficiency was observed to be a very common issue in our critically ill patients (65.4%). The difference between the two groups of age, accepted mortality and urea levels were found to be statistically significant (p<0.05). According to the terms of the patient's vitamin D status, differences were not significant (p=0.269). Vitamin D deficiency in the multivariate analysis was not an independent risk factor for mortality.
Discussion: Vitamin D deficiency occurs quite often in patients with chronic, severe disease. These patients are admitted to the ICU with more serious acute problems. They have high Apache II scores as well as poor prognosis and high mortality rates during ICU. Our results suggest that although vitamin D deficiency is not a real risk factor, it is a supporting factor in explaining increased mortality rates.

Keywords

Vitamin D deficiency, critically ill, intensive care unit

References

• Moniz P, Coelho L, Póvoa P. Antimicrobial stewardship in the intensive care unit: the role of biomarkers, pharmacokinetics, and pharmacodynamics. Adv Ther 2021; 38: 164-79.
• Kaplan M, Duzenli T, Tanoglu A, Cakir Guney B, Onal Tastan Y, Bicer HS. Presepsin: albumin ratio and C-reactive protein: albumin ratio as novel sepsis-based prognostic scores: a retrospective study. Wien Klin Wochenschr 2020; 132: 182-7.
• Karagöz E, Tanoglu A. Mean platelet volume: a novel predictive marker for mortality in intensive care unit (ICU) patients? Clin Respir J 2016; 10: 535-6.
• Grant WB, Holick MF. Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev 2005; 10: 94-111.
• Holick MF. Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J 2005; 98: 1024-7.
• Beyazit Y, Kocak E, Tanoglu A, Kekilli M. Oxidative stress might play a role in low serum vitamin D associated liver fibrosis among patients with autoimmune hepatitis. Dig Dis Sci 2015; 60: 1106-8. 
• Ralph R, Peter JV, Chrispal A, et al. Supraphysiological 25-hydroxy vitamin D3 level at admission is associated with illness severity and mortality in critically ill patients. J Bone Miner Metab 2014; 33: 239-43.
• Henry HL, Bouillon R, Norman AW, et al. 14th Vitamin D Workshop consensus on vitamin D nutritional guidelines, J Steroid Biochem Mol Biol 2010; 121: 4-6.
• Amrein K, Sourij H, G. Wagner G, 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.
• Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266–81.
• Arnson Y, Amital H, Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis 2007; 66: 1137–42.
• Durr UH, Sudheendra US, Ramamoorthy A. LL-37, the only human member of the cathelicidin family of antimicrobial peptides. Biochim Biophys Acta 2006; 1758: 1408–25.
• Wang TT, Nestel FP, Bourdeau V, et al. Cutting edge: 1,25-dihydroxyvitamin D3 is a direct inducer of antimicrobial peptide gene expression. J Immunol 2004; 173: 2909–12.
• Aygencel G, Turkoglu M, Tuncel AF, et al. Is vitamin D insufficiency associated with mortality of critically ill patients? Crit Care Res Pract 2013; 2013: 856747.
• Nair P, Lee P, Reynolds C, et al. Significant perturbation of vitamin D–parathyroid–calcium axis and adverse clinical outcomes in critically ill patients. Intensive Care Med 2013; 39: 267-74.
• Ilie PC, Stefanescu S, Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res 2020; 32: 1195-8.
• Zisi D, Challa A, Makis A. The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood. Hormones (Athens) 2019; 18: 353-63.
• Liu PT, Stenger S, Tang DH, Modlin RL. Cutting edge: vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin. J Immunol 2007; 179: 2060–3.
• Heine G, Anton K, Henz BM, Worm M. 1alpha,25-dihydroxyvitamin D3 inhibits anti-CD40 plus IL-4-mediated IgE production in vitro. Eur J Immunol 2002; 32: 3395–404.
• Adorini L, Penna G, Giarratana N, et al. Dendritic cells as key targets for immunomodulation by Vitamin D receptor ligands. J Steroid Biochem Mol Biol 2004, 89–90: 437–41.
• Baeke F, Takiishi T, Korf H, et al. Vitamin D: modulator of the immune system. Curr Opin Pharmacol 2010; 10: 482–96.
• Baeke F, Gysemans C, Korf H, Mathieu C. Vitamin D insufficiency: implications for the immune system. Pediatr Nephrol 2010; 25: 1597–606.
• Hewison M. Vitamin D and the immune system: new perspectives on an old theme. Endocrinol Metab Clin North Am 2010; 39: 365–79.