Vitamin D Deficiency Is Highly Prevalent in Critically Ill Patients and a Risk Factor for Mortality: A Prospective Observational Study Comparing Noncirrhotic Patients and Patients With Cirrhosis
- 1 October 2018
- journal article
- research article
- Published by SAGE Publications in Journal of Intensive Care Medicine
- Vol. 35 (10), 992-1001
- https://doi.org/10.1177/0885066618803844
Abstract
A 25-hydroxyvitamin D, 25(OH)D, deficiency is common among critically ill patients and correlated with increased mortality. Furthermore, deficiency is associated with advanced liver disease. However, there are no studies available comparing the dimensions and consequences of a 25(OH)D deficiency between patients with and without liver cirrhosis in the setting of intensive care units (ICUs). This study focuses on differences in 25(OH)D status between critically ill noncirrhosis patients and patients with cirrhosis (primary end point), hypothesizing that deficiency and its impact on mortality risk are even more pronounced in patients with cirrhosis. We performed a prospective observational study of 176 patients (noncirrhosis patients, N = 114; patients with cirrhosis, N = 62) with a laboratory assessment of 25(OH)D on ICU admission and survival analyses after 180 days. On admission, 55% of patients showed a severe deficiency, 25(OH)D P < .001). We found extremely low levels particularly in patients without prior vitamin D supplementation (6.0 [4.0-7.5] in patients with cirrhosis vs 8.0 [5.0-12.0] ng/mL in noncirrhosis patients; P = .004). Vitamin D status correlated inversely with the sequential organ failure assessment, acute and physiology chronic health evaluation, model of end-stage liver disease, and Child-Pugh scores. Survival analyses categorized 25(OH)D levels P < .001). In patients with cirrhosis, a severe deficiency (P = .001). In cases of admission levels ≥10 ng/mL, however, mortality risk was similar between patients with cirrhosis and noncirrhosis patients (HR: 1.08, 95% CI = 0.43-2.73; P = .873). Hypovitaminosis D is a highly frequent disorder in critically ill patients admitted to ICU. A severe deficiency with levels <10 ng/mL is a high risk factor for increased mortality, especially in patients with cirrhosis.Keywords
This publication has 48 references indexed in Scilit:
- Accuracy of 6 Routine 25-Hydroxyvitamin D Assays: Influence of Vitamin D Binding Protein ConcentrationClinical Chemistry, 2012
- Strong association between non alcoholic fatty liver disease (NAFLD) and low 25(OH) vitamin D levels in an adult population with normal serum liver enzymesBMC Medicine, 2011
- Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill*Critical Care Medicine, 2011
- Vitamin D deficiency in cirrhosis relates to liver dysfunction rather than aetiologyWorld Journal of Gastroenterology, 2011
- Vitamin D deficiency is associated with mortality in the medical intensive care unitCritical Care, 2011
- Common genetic determinants of vitamin D insufficiency: a genome-wide association studyThe Lancet, 2010
- Vitamin D Status: Measurement, Interpretation, and Clinical ApplicationAnnals of Epidemiology, 2009
- 25-Hydroxyvitamin D Levels and the Risk of Mortality in the General PopulationArchives of Internal Medicine, 2008
- Vitamin D DeficiencyThe New England Journal of Medicine, 2007
- Estimates of optimal vitamin D statusOsteoporosis International, 2005