scholarly journals Vitamin D status and its influence on outcomes following major burn injury and critical illness

2018 ◽  
Vol 6 ◽  
Author(s):  
Khaled Al-Tarrah ◽  
Martin Hewison ◽  
Naiem Moiemen ◽  
Janet M. Lord
Keyword(s):  
Vitamin D ◽  
Critical Illness ◽  
Vitamin D Deficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Thermal Injury ◽  
Burn Injury ◽  
Vitamin D Supplementation ◽  
Burn Patients ◽  
Vitamin D Status

Abstract Vitamin D deficiency is common among the general population. It is also observed in up to 76% of critically ill patients. Despite the high prevalence of hypovitaminosis D in critical illness, vitamin D is often overlooked by medical staff as the clinical implications and consequences of vitamin D deficiency in acute contexts remain to be fully understood. Vitamin D has a broad range of pleotropic effects on various processes and systems including the immune-inflammatory response. 1α,25-dihydroxyvitamin D (1,25(OH)2D), has been shown to promote a tolerogenic immune response limiting deleterious inflammatory effects, modulation of the innate immune system, and enhancement of anti-microbial peptides. Vitamin D deficiency is frequently observed in critically ill patients and has been related to extrinsic causes (i.e., limited sunlight exposure), magnitude of injury/illness, or the treatment started by medical doctors including fluid resuscitation. Low levels of vitamin D in critically ill patients have been associated with sepsis, organ failure, and mortality. Despite this, there are subpopulations of critical illness, such as burn patients, where the literature regarding vitamin D status and its influence on outcomes remain insufficient. Thermal injury results in damage to both burned and non-burned tissues, as well as induces an exaggerated and persistent immune-inflammatory and hypermetabolic response. In this review, we propose potential mechanisms in which burn injury affects the vitamin D status and summarizes current literature investigating the influence of vitamin D status on outcomes. In addition, we reviewed the literature and trials investigating vitamin D supplementation in critically ill patients and discuss the therapeutic potential of vitamin D supplementation in burn and critically ill patients. We also highlight current limitations of studies that have investigated vitamin D status and supplementation in critical illness. Thermal injury influences vitamin D status. More studies investigating vitamin D depletion in burn patients and its influence on prognosis, via standardized methodology, are required to reach definitive conclusions and influence clinical practice.

scholarly journals Up to 40% of COVID-19 Critically Ill Patients Have Vitamin D Deficiency

2020 ◽  
Author(s):  
Teresa-Maria Tomasa-Irriguible ◽  
Lara Bielsa-Berrocal
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Statistical Significance ◽  
Vitamin D Status ◽  
Reactive Protein ◽  
Vitamin D Levels ◽  
Polymerase Chain ◽  
Potential Strategy

Background: Coronavirus disease (COVID-19) has caused more than 745,000 deaths worldwide. Vitamin D has been identified as a potential strategy to prevent or treat this disease. The purpose of the study was to measure vitamin D at hospital admission of COVID-19; Methods: We included critically ill patients with the polymerase chain reaction positive test for COVID-19, from March to April, 2020. Statistical significance was defined as P < .05. All tests were 2-tailed; Results: A total of 35 patients (median age, 60 years; 26 [74.3%] male) were included. Vitamin D levels were categorized as deficient for 14 participants (40%). Vitamin D deficiency was associated with vitamin A (P= 0.003) and Zinc (P= 0.019) deficiency and lower levels of albumin (P= 0.026) and prealbumin (P= 0.009). Overall, none of the studied variables were associated with vitamin D status: mortality, intensive care unit (ICU) or hospital stay, necessity of vasoactive agents, intubation, prone position, C reactive protein (CRP), Dimer-D, Interleukin 6 levels (IL-6), ferritin levels, or bacterial superinfection; Conclusions: In this single-center, retrospective cohort study, deficient vitamin D status was found in 40% in COVID-19 critically ill patients. However, deficient vitamin D status was not associated with inflammation or outcome.

Vitamin D Deficiency/Insufficiency and Challenges in Developing Global Vitamin D Fortification and Supplementation Policy in Adults

2012 ◽  
Vol 82 (4) ◽  
pp. 237-259 ◽  
Author(s):  
Moshe Ben-Shoshan
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Search Strategy ◽  
Epidemiologic Studies ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Societal Burden ◽  
Time Period ◽  
New Guidelines ◽  
In Cis

This review summarizes studies discussing vitamin D status in adults and reveals that vitamin D deficiency/insufficiency is highly prevalent in adults and that current fortification and supplementation policies are inadequate. Background and aims: Studies suggest a crucial role for adequate vitamin D status in various health conditions including bone metabolism, cancer, cardiovascular diseases, and allergies. However, relatively little is known about poor vitamin D status and unmet needs in adults. This report aims to highlight the contribution of epidemiologic studies (through the identification of health effects and societal burden) to the development of vitamin D fortification and supplementation policies and reveal unmet global challenges in adults. Methods: In order to assess worldwide vitamin D status in adults, the search strategy combined the medical literature database MEDLINE (using PubMed) for the time period between January 1, 1980 and February 28, 2011, using the key words “vitamin D” “deficiency” and “insufficiency”, and included articles in which access to full text was possible and in which healthy adults were assessed according to one of four commonly used vitamin D threshold classifications. Results: This report reveals that vitamin D deficiency occurs in 4.10 % [95 % CI (confidence interval), 3.93 %, 4.27 %] to 55.05 % (54.07 %, 56.03 %) of adults, while insufficiency occurs in 26.07 % (24.82 %, 27.33 %) to 78.50 % (77.85 %, 79.16 %), depending on the classification used. However, lack of overlap in CIs and high value of I2 statistics indicate considerable heterogeneity between studies. Further, certain populations (i. e. dark-skinned individuals, immigrants, and pregnant women) may be at higher risk for poor vitamin D status. Conclusion: Current policies for vitamin D supplementation and fortification are inadequate and new guidelines are required to improve vitamin D status in adults.

11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S13-S14
Author(s):  
Sarah Zavala ◽  
Kate Pape ◽  
Todd A Walroth ◽  
Melissa A Reger ◽  
Katelyn Garner ◽  
...  
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Burn Patients ◽  
Comfort Care ◽  
The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

scholarly journals Vitamin D status and overall and sepsis mortality in critically ill patients

Critical Care ◽  
2013 ◽  
Vol 17 (S2) ◽  
Author(s):  
P Zajic ◽  
C Schnedl ◽  
T Valentin ◽  
A Grisold ◽  
A Holl ◽  
...  
Keyword(s):  
Vitamin D ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vitamin D Status ◽  
Sepsis Mortality

scholarly journals Skeletal and Extraskeletal Actions of Vitamin D: Current Evidence and Outstanding Questions

2018 ◽  
Vol 40 (4) ◽  
pp. 1109-1151 ◽  
Author(s):  
Roger Bouillon ◽  
Claudio Marcocci ◽  
Geert Carmeliet ◽  
Daniel Bikle ◽  
John H White ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Human Subjects ◽  
Osteoporotic Fractures ◽  
Vitamin D Supplementation ◽  
Current Evidence ◽  
Elderly Subjects ◽  
Vitamin D Status ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

AbstractThe etiology of endemic rickets was discovered a century ago. Vitamin D is the precursor of 25-hydroxyvitamin D and other metabolites, including 1,25(OH)2D, the ligand for the vitamin D receptor (VDR). The effects of the vitamin D endocrine system on bone and its growth plate are primarily indirect and mediated by its effect on intestinal calcium transport and serum calcium and phosphate homeostasis. Rickets and osteomalacia can be prevented by daily supplements of 400 IU of vitamin D. Vitamin D deficiency (serum 25-hydroxyvitamin D <50 nmol/L) accelerates bone turnover, bone loss, and osteoporotic fractures. These risks can be reduced by 800 IU of vitamin D together with an appropriate calcium intake, given to institutionalized or vitamin D–deficient elderly subjects. VDR and vitamin D metabolic enzymes are widely expressed. Numerous genetic, molecular, cellular, and animal studies strongly suggest that vitamin D signaling has many extraskeletal effects. These include regulation of cell proliferation, immune and muscle function, skin differentiation, and reproduction, as well as vascular and metabolic properties. From observational studies in human subjects, poor vitamin D status is associated with nearly all diseases predicted by these extraskeletal actions. Results of randomized controlled trials and Mendelian randomization studies are supportive of vitamin D supplementation in reducing the incidence of some diseases, but, globally, conclusions are mixed. These findings point to a need for continued ongoing and future basic and clinical studies to better define whether vitamin D status can be optimized to improve many aspects of human health. Vitamin D deficiency enhances the risk of osteoporotic fractures and is associated with many diseases. We review what is established and what is plausible regarding the health effects of vitamin D.

scholarly journals Impact of Vitamin D Deficiency on Reproductive Outcome in Infertile Anovulatory Women with Polycystic Ovary Syndrome: A Systematic Literature Review

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1774-1774
Author(s):  
Yasmine Abuzeid
Keyword(s):  
Vitamin D ◽  
Literature Review ◽  
Vitamin D Deficiency ◽  
Ovulation Induction ◽  
Polycystic Ovary ◽  
Endometrial Thickness ◽  
Vitamin D Supplementation ◽  
Vitamin D Status ◽  
Ovary Syndrome ◽  
Live Birth Rates

Abstract Objectives To assess existing evidence of the impact of vitamin D deficiency on reproductive success in infertile anovulatory females with polycystic ovary syndrome (PCOS) and evaluate the possible need for vitamin D supplementation. Methods A systematic literature review of published studies (2009–2019) on this topic was performed. One investigator independently reviewed primary research articles, extracted details, and determined the quality of each study. Results Of 64 peer-reviewed articles identified, 5 were reviewed, 5 were of plus/positive quality. Two studies assessed the prevalence of vitamin D deficiency in PCOS patients. One study assessed vitamin D administration effect on endometrial thickness, and two studies evaluated the effect of vitamin D status on ovulation and live birth rates after ovulation induction. Conclusions Vitamin D deficiency is prevalent in PCOS patients. Vitamin D status is an independent predictor of reproductive success in anovulatory patients with PCOS during ovulation induction. In such patients, vitamin D deficiency is associated with decreased ovulation and live birth rates, and vitamin D supplementation improves endometrial thickness. Based on the current data, further research is needed; meanwhile clinicians should monitor vitamin D status and recommend vitamin D supplementation to infertile anovulatory PCOS women with vitamin D deficiency. Funding Sources None.

scholarly journals The association between vitamin D levels and burn factors in different burn types

2020 ◽  
Vol 8 ◽  
Author(s):  
Yoon Soo Cho ◽  
Cheong Hoon Seo ◽  
So Young Joo ◽  
Suk Hoon Ohn
Keyword(s):  
Vitamin D ◽  
Wound Healing ◽  
Vitamin D Deficiency ◽  
Burn Injury ◽  
Linear Regression Analysis ◽  
Burn Patients ◽  
Rehabilitation Therapy ◽  
Vitamin D Levels ◽  
Flame Burn ◽  
Intensive Rehabilitation

Abstract Background Patients with burns present with different clinical features depending on the types of burn injury and burn patients with lower levels of vitamin D have worse prognoses and more complications. The study aims to investigate the association between vitamin D levels and burn factors according to each burn type in relation to early intensive rehabilitation therapy initiated for inpatients with burns. Methods In this retrospective study, we enrolled 757 of 1716 inpatients who underwent rehabilitative therapy between May 2013 and April 2017. Burn types were divided into flame burn, electrical burn and other burns, including scalding, contact and chemical burns. Age, burned body surface area (BSA), wound healing time (WHT), length of hospital stay (LOS) and body mass index were analysed between vitamin D deficient and non-deficient patient groups using Student’s t-tests, or Mann-Whitney U test and among three burn types using one-way analysis of variance (ANOVA) or Kruskal-Wallis one-way ANOVA. The relationship between vitamin D levels and burn factors was evaluated using Pearson's or Spearman's correlation coefficient tests, and multiple linear regression analysis in different burn groups. Results In total, 88.9% patients were vitamin D deficient, and these patients had a larger burned BSA (p = 0.015) and longer WHT and LOS (all p &lt; 0.001) than non-deficient patients. Burned BSA, WHT and vitamin D levels showed significant differences in their mean values according to three burn types (all p &lt; 0.001). WHT was a communal factor significantly associated with vitamin D levels in all three burn types (p &lt; 0.05). The WHT cut-off points to predict vitamin D deficiency were 55 days for flame burn (p &lt; 0.001) and 62.5 days for electrical burn (p = 0.001). Conclusions WHT across all three burn types was a common factor associated with vitamin D levels for inpatients with burns who had undergone rehabilitative therapy. Electrical burn patients with vitamin D deficiency, even those with a low burned BSA percentage, showed prolonged wound healing over a two-month post-burn period. Independent of burned BSA, nutritional intervention concerning vitamin D in relation to burn wound healing should be considered to guide early initiation of intensive rehabilitation therapy.

MON-PO611: Vitamin D Status and Inflammatory Bio-Markers in Critically Ill Patients with Sepsis

2019 ◽  
Vol 38 ◽  
pp. S285-S286
Author(s):  
L.S. Alnasrallah ◽  
M.M.A. Abulmeaty ◽  
A.M. Almajwal ◽  
Y. Arabi ◽  
H. Aldorzih ◽  
...  
Keyword(s):  
Vitamin D ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Vitamin D Status
Sign in / Sign up

Export Citation Format

Share Document