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Do we need vitamin D screening and supplementation in critically ill patients?

Ahmad Amouzeshi¹, Ali Rajabpour-Sanati^2*, Ali Mohammad Pourbagher Shahri²

¹Associate Professor, Department of Cardiac Surgery, Birjand University of Medical Sciences, Birjand, Iran

²MD, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran

Received: June 03, 2018 Revised: December 20, 2018 Accepted: January 13, 2019

Dear Editor

Vitamin D deficiency or insufficiency affects about 30% of children and 60% of adults across the world (1). This condition also occurs in about 70% of critically ill patients (2). Although vitamin D is typically known as a fat-soluble vitamin in bone metabolism, it is a steroid hormone with pleiotropic effects (3). Vitamin D deficiency
can lead to cardiovascular, neurological, and autoimmune diseases and different types of cancers, including the breast, prostate, lung, colon, and renal cancers. Accordingly, this deficiency has a direct correlation with mortality (4-6).

Many critically ill patients enter the Intensive Care Unit (ICU) with a deficient level of vitamin D. Disrupted metabolism of vitamin D in some critically ill patients results in a fast decrease in vitamin D levels after ICU admission (7). It has been well documented that vitamin D deficiency is associated with increased morbidity, mortality, and ICU length of stay (8, 9). The randomized clinical trials having been performed in recent years are indicative of no significant improvement in the clinical outcome of critically ill patients supplemented with vitamin D (10).

The ICU admission can be predicted in several conditions, such as some elective surgeries and intensive chemotherapies (7). Furthermore, one of the problems of the studies performed till now is that they have not exclusively investigated the patients with vitamin D deficiency. However, the exclusive inclusion of patients with vitamin D deficiency can lower the sample size for a clinical trial.

It is required to perform randomized clinical trials with a reasonable sample size to investigate the effect of vitamin D supplementation among vitamin D deficient patients who are in a critical medical state. These studies will be useful for the better conceptualization of treatment with vitamin D in critically ill patients.

Conflicts of Interest

There is no conflict of interest to be declared.

References

1.     Daly RM, Gagnon C, Lu ZX, Magliano DJ, Dunstan DW, Sikaris KA, et al. Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population‐based study. Clin Endocrinol (Oxf). 2012; 77(1):26-35. PMID: 22168576 DOI: 10.1111/j.1365-2265.2011.04320.x

2.     Dickerson RN, Van Cleve JR, Swanson JM, Maish GO 3rd, Minard G, Croce MA, et al. Vitamin D deficiency in critically ill patients with traumatic injuries. Burns Trauma. 2016; 4(1):28. PMID: 27833924 DOI: 10.1186/s41038-016-0054-8

3.     Christakos S, Dhawan P, Verstuyf A, Verlinden L, Carmeliet G. Vitamin D: metabolism, molecular mechanism of action, and pleiotropic effects. Physiol Rev. 2015; 96(1):365-408. PMID: 26681795 DOI: 10.1152/physrev.00014.2015

4.     Mondul AM, Weinstein SJ, Layne TM, Albanes DJ. Vitamin D and cancer risk and mortality: state of the science, gaps, and challenges. Epidemiol
Rev. 2017; 39(1):28-48. PMID: 28486651 DOI: 10.1093/epirev/mxx005

5.     Mozos I, Marginean OJ. Links between vitamin D deficiency and cardiovascular diseases. Biomed Res Int. 2015; 2015:109275. PMID: 26000280 DOI: 10.1155/2015/109275

6.     Mpandzou G, Aït Ben Haddou E, Regragui W, Benomar A, Yahyaoui M. Vitamin D deficiency and its role in neurological conditions: a review. Rev Neurol (Paris). 2016; 172(2):109-22. PMID: 26867662 DOI: 10.1016/j.neurol.2015.11.005

7.     Amrein K, Papinutti A, Mathew E, Vila G, Parekh D. Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa. Endocr Connect. 2018; 7(12):R304-15. PMID: 30352414 DOI: 10.1530/EC-18-0184

8.     Zhang YP, Wan YD, Sun TW, Kan QC, Wang LX. Association between vitamin D deficiency and mortality in critically ill adult patients: a meta-analysis of cohort studies. Crit Care. 2014; 18(6):684. PMID: 25498305 DOI: 10.1186/s13054-014-0684-9

9.     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. PMID: 25475621 DOI: 10.1186/s13054-014-0660-4

10. Langlois PL, Szwec C, D'Aragon F, Heyland DK, Manzanares W. Vitamin D supplementation in the critically ill: a systematic review and meta-analysis. Clin Nutr. 2018; 37(4):1238-46. PMID: 28549527 DOI: 10.1016/j.clnu.2017.05.006