Yoğun Bakım Ünitesinde Tedavi Edilen Yaşlı Hastaların D Vitamini Düzeylerinin Prognoz Üzerine Etkisi

Öz

Giriş ve Amaç: Dünyada yaşlı nüfusun %50-60’ında vitamin D eksikliği vardır. Kritik hastalarda ise vitamin D eksikliğinin (25(OH)D<20ng/ml) prevalansı %70’i aşmaktadır. Bu çalışmada Yoğun Bakım Ünitesi(YBÜ)’nde takip ve tedavi edilen 65 yaş üstü; vitamin D verilen ve verilmeyen hastaların prognoz açısından karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Kasım 2014-Nisan 2015 tarihleri arası hastanemiz YBÜ ’de takip ve tedavi edilen hastaların kayıtları geriye dönük olarak incelendi. Enteral beslenen ve vitamin D desteği alan 20 hasta (Grup D), enteral beslenen ancak vitamin D desteği almayan 20 hasta (Grup K) arasında yoğun bakıma kabul sırasında(T1), 7.(T2) ve 15.(T3) günlerde ölçülen vitamin D, albümin, prealbumin, total lenfosit, CRP düzeyleri ve triceps kas kalınlığı açısından fark olup olmadığı değerlendirildi. Bulgular: İki grup demografik veriler açısından benzerdi. Grup D ile Grup K arasında T1,T2 ve T3 zamanlarında vitamin D düzeyleri, albümin- prealbümin düzeyleri, enfeksiyon oranları, mekanik ventilasyon süreleri, yoğun bakım yatış günü ve mortalite açısından istatistiksel olarak anlamlı bir fark saptanmazken T1 ve T2 zamanında total lenfosit(TLS) düzeyleri(p<0,05) vitamin D grubunda istatistiksel olarak anlamlı yüksek idi. Hastaların sadece T3 zamanında vitamin D ve diğer değişkenler ele alındığında ise APACHE II değerleri, MV gün, T3 albümin, T3 prealbümin ve T3 total proteinle istatistiki olarak anlamlı ilişki gözlendi. Sonuç: Çalışmamızda vitamin D verilen grupla verilmeyen grup arasında bazı değişkenlerde anlamlı fark gözlenmesi, prospektif ve daha fazla sayıda hasta ile yapılacak çalışmalar açısından yol gösterici olacağını düşünmekteyiz.

Anahtar Kelimeler

• Vitamin D,yaşlı hasta,yoğun bakım

The effect of vitamin-d levels on prognosis of elderly patients treated in intensive care unit

Öz

Background : 50-60% of elderly population in the world has vitamin D deficiency. In critically ill patients, the prevalence of vitamin D deficiency (25 (OH) D <20 ng / ml) exceeds 70%. The aim of this study was to compare the prognosis of patients over 65 years of age with and without vitamin D supplementation in the Intensive Care Unit (ICU). Materials and Methods: The records of patients who were followed-up and treated in our hospital between November 2014 and April 2015 were retrospectively reviewed. The patients were grouped as enteral-fed with vitamin D supplementation (20 patients, Group D) and enterally fed without vitamin D supplementation (20 patients, Group K). Vitamin D, albumin, prealbumin, total lymphocyte, CRP levels and triceps muscle thickness were measured during the admission to intensive care unit (T1), on days 7 (T2) and 15 (T3). Results: The two groups were similar in terms of demographic data. There was no statistically significant difference between Group D and Group K in terms of vitamin D levels, albumin-prealbumin levels, infection rates, duration of mechanical ventilation, intensive care unit stay and mortality in T1, T2 and T3 times, while total lymphocyte levels (p <0,05) in T1 and T2 were statistically significant in vitamin D group. When vitamin D and other variables were evaluated at time T3, a statistically significant relationship was observed with APACHE II values, MV day, T3 albumin, T3 prealbumin and T3 total protein. Conclusion: In our study, a significant difference was observed between the vitamin D supplementation group and the group which was not given. In our opinion, the result of this study will be a guide to prospective randomized trials involving more patients.

Anahtar Kelimeler

• Vitamin D,elderly patient,intensive care unit

Kaynakça

1. 1.Marik PE. Management of the critically ill geriatric patient. Cri Care Med 2006; 34: 176-82.
2. 2.Holick MF. Vitamin D: a D-light fulhealth perspective. Nutr Rev 2008;66:182-94.
3. 3.Hyppönen E, Boucher BJ, Berry DJ, Power C. 25-hydroxyvitamin D, IGF-1, and metabolic syndrom at 45 years of age: a cross-sectionalstudy in the 1958 British Birth Cohort. Diabetes 2008;57:298-305.
4. 4. Lee P, Eisman JA, Center JR. Vitamin D Deficiency in Critically Ill Patients. N Engl J Med 2009; 360:1912-1914April 30, 2009DOI: 10.1056/NEJMc08099967. authors.NEJM.org
5. 5.Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol 2014; 2: 76-89.
6. 6.de Haan K, Groeneveld AB, de Geus HR, Egal M, Struijs A. Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis. Crit Care 2014; 18: 660.
7. 7. Gilbert CR, Arum SM, Smith CM. Vitamin D deficiency and chronic lung disease. Can Respir J 2009;16:75-80.
8. 8. Sadeq A. Quraishi,, Edward A. Bittner, Livnat Blum. Prospective Study of Vitamin D Status at Initiation of Care in Critically Ill Surgical Patient sand Risk of 90-Day Mortality. Crit. Caremed. 2014 Jun;42(6):1365-1371.

9. 9.Kvaran RB, Sigurdsson MI, Skarphedinsdottir SJ, Sigurdsson GH.Severe vitamin D deficiency is common in criticallyillpatients at a highnorthernlatitude.2016 Oct;60(9):1289-96. doi: 10.1111/aas.12748. Epub 2016 Jun 12.
10. 10.Arnson Y, Gringuaz I, Itzhaky D, Amithal H. Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients. QJM 2012;105:633-9
11. 11.Venkatram S, Chilimuri S, Adrish M at al. Vitamin D deficiency is associated with mortality in the medical intensive care unit. Crit Care 2011;15:R292.
12. 12. Ünal T, Özkan B, Çayır A, ve ark. Serum 25(OH) D vitamin düşüklüğü çocukluk çağı pnömonileri için bir risk faktörü müdür? Dicle Tıp Dergisi 2012;39:531- 535.
13. 13. Pilz S, Tomaschitz A, Drechsler C, de Boer RA. Vitamin D deficiency and heart disease. Kidney International Supplements 2011;1:111-115.
14. 14. Schöttker B, Haug U, Schomburg L,Köhrle J,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 97: 782-793, 2013.
15. 15.Gröber U,Reichrath J, Holic MF. Live longer with vitamin D? Nutrients 7:1871-1880,2015.
16. 16. Bivona G, Agnello L, Ciaccio M.VitaminD and Immunomodulation: Is It Time to Change the Reference Values? Ann Clin Lab Sci. 2017 Aug;47(4):508-510.
17. 17. Vanherwegen AS, Gysemans C, Mathieu C.Vitamin D endocrinology on the cross-road between immunity and metabolism. Mol Cell Endocrinol. 2017 Sep 15;453:52-67. doi: 10.1016/j.mce.2017.04.018. Epub 2017 Apr 28.
18. 18. Gürbüz P, Yetiş G. Yaşlılarda D Vitamini Eksikliği. İ.Ü. Sağlık Hizmetleri Meslek Yüksekokulu Dergisi, ISSN:2147-7892, Cilt 5, Sayı 2(2017).
19. 19. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 2007; 167: 1730-7.
20. 20. Bjelakovic G, Gluud LL, Nikolova D, At al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2011; CD007470.
21. 21. Ross AC, Manson JE, Abrams SA, At 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 96: 53-58, 2011.
22. 22.Rosen CJ, Abrams SA, Aloia JF, At al. IOM committee members respond to Endocrine Society vitamin D guideline. J Clin Endocrinol Metab 97: 1146-1152, 2012.
23. 23. Hintzpeter B, Mensink GB, Thierfelder W, Müller MJ, Scheidt-NaveC: Vitamin D status and health correlates among German adults. Eur J Clin Nutr 62: 1079-1089, 2008.
24. 24. Pilz S, Grübler M, Gaksch M, At al. Vitamin D and Mortality.Anticancer Res. 2016 Mar;36(3):1379-87.
25. 25. Wu H, Pang Q.The effect of vitamin D and calcium supplementation on falls in older adults : A systematic review and meta-analysis. Orthopade. 2017 Sep;46(9):729-736. doi: 10.1007/s00132-017-3446-y.
26. 26. Bischoff-Ferrari HA, Willett WC, Orav EJ, At al. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med 367: 40-49, 2012.
27. 27. Reid IR. Vitamin D Effect on Bone Mineral Density and Fractures.Endocrinol Metab Clin North Am. 2017 Dec;46(4):935-945. doi: 10.1016/j.ecl.2017.07.005. Epub 2017 Sep 29.
28. 28. Amrein K, Schnedl C, Holl A, At 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.
29. 29. Atalan HK , Güçyetmez B. Serum Vitamin D Level at ICU Admission and Mortality. Turk J Anaesthesiol Reanim 2017; 45: 193-6 DOI: 10.5152/TJAR.2017.60234