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  • Title: Significant perturbation of vitamin D-parathyroid-calcium axis and adverse clinical outcomes in critically ill patients.
    Author: Nair P, Lee P, Reynolds C, Nguyen ND, Myburgh J, Eisman JA, Center JR.
    Journal: Intensive Care Med; 2013 Feb; 39(2):267-74. PubMed ID: 23064465.
    Abstract:
    PURPOSE: A prospective multicentre cohort study was conducted to determine the prevalence of hypovitaminosis D in adult critically ill patients, to characterize alterations in the parathyroid hormone (PTH)-vitamin D-calcium axis and to explore associations between hypovitaminosis D and adverse clinical outcomes. METHODS: Demographic, disease severity scores and clinical outcome data were collected in 100 consecutive patients with expected intensive care unit (ICU) admission of at least 2 days. Levels of 25-hydroxyvitamin D (25-OH-D), 1,25-dihydroxyvitamin D (1,25-(OH)(2)-D), PTH and ionized calcium were measured on days 1, 3 and on day 7 or ICU discharge. RESULTS: The prevalence of vitamin D insufficiency (25 nmol/L ≤ 25-OH-D ≤ 50 nmol/L) and deficiency (25-OH-D < 25 nmol/L) were 54 and 24 %, respectively, and levels did not recover during ICU stay. Admission 25-OH-D levels correlated with 1,25-(OH)(2)-D (R = 0.61, p = 0.001), Simplified Acute Physiology Score (SAPS-II) (R = -0.3, p = 0.01), Acute Physiology and Chronic Health Evaluation (APACHE-II) scores (R = -0.2, p = 0.05), but not calcium (R = 0.16, p = 0.11) or PTH (R = -0.11, p = 0.31) levels. Vitamin D deficiency was associated with fewer hospital-free days, OR 3.15 (1.18-8.43) in univariate analysis. Secondary hyperparathyroidism (PTH > 7 pmol/L) was observed in 37.5 % of hypocalcaemic and 32.5 % of vitamin D insufficient/deficient patients, and was associated with higher SAPS-II [43 (31.3-60) vs. 36 (30-43), p = 0.03]. CONCLUSIONS: Hypovitaminosis D and secondary hyperparathyroidism are highly prevalent in critically ill patients. Low vitamin D status persists during ICU stay and is associated with worse disease severity and fewer hospital-free days.
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