The Effect of Vitamin D Supplement on Outcomes in Patients with Traumatic Injuries Hospitalized in Intensive Care Unit: A Clinical Trial Study

Document Type : Original Article (s)

Authors

1 Associate Professor, Anesthesiology and Critical Care Research Center AND Nosocomial Infection Research Center AND Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

4 Resident, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: As published in literature, vitamin D deficiency lead to increased morbidity and mortality rate in patients who hospitalized in intensive care units (ICUs). The present study conducted to evaluate the effect of vitamin D supplement on outcomes in patients with traumatic injuries hospitalized in ICU.Methods: In a clinical trial study, 55 patients with low levels of vitamin D (less than 30 ng/ml) and 55 patients with normal levels of vitamin D were selected from the patients admitted to the ICU of Alzahra hospital, Isfahan, Iran. The patients suffering hypovitaminosis D (interventional group) received 300,000 units of vitamin D intramuscularly. Patients who had adequate vitamin D levels were considered as control group. The patients’ recovery from the ICU was evaluated and compared by the Sequential Organ Failure Assessment (SOFA) index.Findings: SOFA scores were significantly higher in vitamin D deficiency group in first 2 weeks after hospitalization. Serum vitamin D levels at the end of the 3rd week had no statistical different between the two groups. The discharge rate in vitamin D deficiency group in first 2 weeks were lower than control group significantly. But at the end of the third week, the difference between the two groups was not significant.Conclusion: The results of our study showed that vitamin D supplement increased discharge rate of traumatic patients hospitalized in ICU.

Keywords


  1. Kiss CM, Byham-Gray L, Denmark R, Loetscher R, Brody RA. The impact of implementation of a nutrition support algorithm on nutrition care outcomes in an intensive care unit. Nutr Clin Pract 2012; 27(6): 793-801.
  2. Tabatabaeizadeh SA, Avan A, Bahrami A, Khodashenas E, Esmaeili H, Ferns GA, et al. High dose supplementation of vitamin D affects measures of systemic inflammation: Reductions in high sensitivity c-reactive protein level and neutrophil to lymphocyte ratio (NLR) distribution. J Cell Biochem 2017; 118(12): 4317-22.
  3. Hovsepian S, Amini M, Aminorroaya A, Amini P, Iraj B. Prevalence of vitamin D deficiency among adult population of Isfahan City, Iran. J Health Popul Nutr 2011; 29(2): 149-55.
  4. Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. Vitamin D: An evidence-based review. J Am Board Fam Med 2009; 22(6): 698-706.
  5. Melamed ML, Michos ED, Post W, Astor B. 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 2008; 168(15): 1629-37.
  6. Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmun Rev 2013; 12(10): 976-89.
  7. Brook K, Camargo CA, Christopher KB, Quraishi SA. Admission vitamin D status is associated with discharge destination in critically ill surgical patients. Ann Intensive Care 2015; 5(1): 23.
  8. Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg 2012; 204(1): 37-43.
  9. Quraishi SA, McCarthy C, Blum L, Cobb JP, Camargo CA. Plasma 25-hydroxyvitamin D levels at initiation of care and duration of mechanical ventilation in critically Ill surgical patients. JPEN J Parenter Enteral Nutr 2016; 40(2): 273-8.
  10. Guan J, Karsy M, Brock AA, Eli IM, Ledyard HK, Hawryluk GWJ, et al. A prospective analysis of hypovitaminosis D and mortality in 400 patients in the neurocritical care setting. J Neurosurg 2017; 127(1): 1-7.
  11. Amrein K, Zajic P, Schnedl C, Waltensdorfer A, Fruhwald S, Holl A, et al. Vitamin D status and its association with season, hospital and sepsis mortality in critical illness. Crit Care 2014; 18(2): R47.
  12. Crist, B, Hood, M, Murtha, Y. Prevalence of vitamin D deficiency in orthopaedic trauma patients. Proceedings of the Annual Meeting of the Orthopaedic Trauma Association; 2012 Oct 3-16; Minneapolis, MN, USA.
  13. Izadpanah M, Khalili H. Potential benefits of vitamin D supplementation in critically ill patients. Immunotherapy 2013; 5(8): 843-53.
  14. Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E, et al. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med 2011; 39(4): 671-7.
  15. Dickerson R, Cleve J, Swanson J, Maish G, Minard G, Croce M, et al. Vitamin D deficiency in critically ill patients with traumatic injuries. Burns Trauma 2016; 4.
  16. Danner OK, Burbank R, Dennis-Griggs D, Wilson KL, Jones F, Taha A, et al. Vitamin D insufficiency is associated with a higher risk of in-hospital mortality in critically-injured trauma patients. EC Nutrition 2015; 4(6): 996-1005.
  17. Han JE, Jones JL, Tangpricha V, Brown MA, Brown LAS, Hao L, et al. High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled Trial. J Clin Transl Endocrinol 2016; 4: 59-65.
  18. Venkatram S, Chilimuri S, Adrish M, Salako A, Patel M, Diaz-Fuentes G. Vitamin D deficiency is associated with mortality in the medical intensive care unit. Crit Care 2011; 15(6): R292.
  19. 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(6): 660.
  20. Moraes RB, Friedman G, Wawrzeniak IC, Marques LS, Nagel FM, Lisboa TC, et al. Vitamin D deficiency is independently associated with mortality among critically ill patients. Clinics (Sao Paulo) 2015; 70(5): 326-32.