Original Study
Relationship Between Vitamin D Status and ICU Outcomes in Veterans

https://doi.org/10.1016/j.jamda.2010.04.004Get rights and content

Objective

Vitamin D deficiency remains a poorly recognized pandemic and is closely linked to increased health care costs in veterans. Projected health care needs in veterans are expected to increase over the next decade. Intensive care unit (ICU) costs contribute significantly to hospital costs and stem from intervention services and management of sepsis including nosocomial infections. Vitamin D has immunomodulating and antimicrobial properties through antimicrobial peptides such as cathelicidin.

Design/Methods

A retrospective study was undertaken to evaluate if vitamin D deficiency was associated with less than optimal ICU outcomes in veterans. The study included 136 veterans with 25(OH)D levels drawn within a month of admission to ICU.

Results

The average 25(OH)D level was 24.6 ng/mL (normal range 30–100) with 38% of patients falling in the vitamin D–deficient category (<20 ng/mL). ICU survivors had a significantly lower rate of vitamin D deficiency compared with nonsurvivors (28% versus 53%). Twenty-nine percent of vitamin D–replete patients were in ICU 3 days or more, whereas 58% of patients with vitamin D deficiency stayed in ICU 3 days or longer. This difference was highly significant translating to twofold increased risk (2.0 Relative Risk [RR]) for 3-day or longer stay in ICU for patients with vitamin D deficiency. Moreover, the risk of death was significantly higher in ICU patients with vitamin D deficiency (RR 1.81).

Conclusion

A vitamin D–replete state may reduce costs and confer survival advantages in critical illness. We recommend that 25(OH)D levels be routinely checked and deficiencies treated in ICU patients.

Section snippets

Methods

The study was conducted at a veterans Affairs (VA) facility in the Southeastern United States. The Research and Development Committee at the VA Medical Center and the Institutional Review Board at the affiliated university approved the study. Data were obtained electronically through retrospective medical record review after personal information was redacted. The study group included all patients admitted to the ICU over a 10-year period (October 1, 1999 to October 1, 2009) with a serum

Results

A total of 136 patients with reported vitamin D levels were identified: 42 admitted to the surgical intensive care unit (SICU) and 94 admitted to the medical intensive care unit (MICU). As MICU and SICU patients did not differ significantly with regard to vitamin D level or deficiency status (P > .05), further analyses combined the 2 groups for a total of 136 patients. Of the 136 patients, 50 (37%) had vitamin D levels checked before admission, whereas the remainder had vitamin D levels

Discussion

Vitamin D deficiency was associated with increased length of stay and mortality among veterans admitted to ICU. Vitamin D deficiency can be associated with self-neglect in the elderly.19 It is possible that vitamin D deficiency at the onset of acute illness may contribute to less than optimal outcomes and may add to the protracted recovery seen in some of these patients.20

Jeng et al15 demonstrated that critical illness was associated with lower 25(OH)D levels. The lower albumin levels seen in

Acknowledgments

The assistance of Perry Jackson and Patsy Ellis, Medical Library at Mountain Home VAMC, and Dr Joy Wachs, East Tennessee State University College of Nursing, are gratefully acknowledged.

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    This material is the result of work supported with resources and the use of facilities at Mountain Home VA Medical Center in Johnson City, Tennessee. The contents of this paper do not represent the views of the Department of Veterans Affairs or the US government.

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