Vitamin-D Deficiency in Critically Ill Patients: A Prospective Observational Study

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 238-262-Vitamin D Action, Deficiency & Disorders
Bench to Bedside
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-253
Mauro Antonio Czepielewski*1, Gilberto Friedman2, Yury Wawrzeniak Christmann3, Marcio Fabiano Nagel3, Thiago Costa Lisboa3, Leonardo S Marques3, Laisa Bonzanini3, Manuela M Marimon3, Luiza Burin3, Helena T Schroeder3, Maurício Vieira Rodrigues3 and Rafael B Moraes3
1Faculdade de Medicina UFRGS, Porto Alegre, Brazil, 2Serviço de Medicina Intensiva, Porto Alegre, Brazil, 3Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
Despite of vitamin D (VITD) effects in bone metabolism, immunomodulation and cardiac contractility, there is insufficient data related to the impact of VITD deficiency (VITD def) in critically ill patients. Observational trials have reported high prevalence of DEF VITD in theses patients, suggesting an association between VITD def and mortality. Several outstanding issues remain, such as what values of VITD relate to morbidity and mortality, as well as its association with severity scores and behavior of VITD during hospitalization. We performed this study aiming  to identify correlation between DEFvitD and mortality and morbiditiy in critically ill patients.  METHODS: Between March and November 2012 we prospectively allocated 135 ICU patients  in tertiary care, university hospital in southern Brazil (30 ° 05'S). We included patients with length of hospital stay prior to ICU < 3 days. Exclusion criteria: < 18 years; cardiac or elective surgeries; chronic renal failure requiring dialysis or creatinine> 2 mg / dL; expected ICU stay< 3 days, expecting death <24 hours; pregnant women, patients with tuberculosis, sarcoidosis, hypo / hyperparathyroidism. We measured demographic data, APACHE II, SOFA, ΔSOFA, lactate, C-reactive protein (CRP), PTH and serum 25 - OH-VITD (CMIA) on admission and weekly until discharge. We measured up duration of mechanical ventilation (MV), length of ICU and hospital stay, mortality, positivity of cultures and infections. RESULTS: Profile of population: VITD = 15.74 ± 9.9 ng/ml. 75% of patients had VITD <20 ng/ml. Women = 47.4%; caucasians = 78%; medical patients = 75%; age = 56 ± 16 y; APACHE = 19.2 ± 8.5; SOFA = 5.8 ± 4.5;  CRP = 91 (26-236), PTH = 124 (58-217). Patients with VITD> 12 ng/ml had lower BMI: 26.3 ± 4.6 x 30.4 ± 8.6. Area under ROC curve of VITD for mortality was 0.61 (95% CI: 0.495 to 0.73), similar to APACHE: 0.7 (CI 95%: 0.59 to 0.8) and SOFA: 0.7 (CI 95%: 0.6 to 0.8) and inferior to ΔSOFA: 0.82 (CI 95%: 0.72 to 0.92). The point of 11.9 ng/ml had a sensitivity of 62% and specificity of 65%. Patients  with VITD levels  <12 ng/ml had a higher hospital mortality (Kaplan-Meier: 18% vs. 63%, p = 0.026), but no differences in duration of mechanical ventilation. The cutoff of 20 ng/ml shows no statistical difference when evaluating any of the above outcomes.The fall of VITD levels was significant among patients with higher levels of VITD, there was a positive correlation between initial and VITD’s fall during hospitalization.
CONCLUSION: VITDDEF was not superior to prognostic indicators commonly used in the ICU, as SOFA, APACHE or SOFA Δ in predicting mortality. The cutoff of 12 ng/ml was associated with higher hospital mortality. These data suggest that severe deficiency, and not insufficiency VITD relates to mortality in critically ill patients and may constitute cutoff point to define VITD supplementation in critically ill patients. This hypothesis should be tested in future clinical trials.

Nothing to Disclose: MAC, GF, YWC, MFN, TCL, LSM, LB, MMM, LB, HTS, MVR, RBM

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: PPG Endocrinologia, Faculdade de Medicina, UFRGS; FIPE, HCPA