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Published in: Intensive Care Medicine 12/2009

01-12-2009 | Clinical Perspective

Vitamin D deficiency in the intensive care unit: an invisible accomplice to morbidity and mortality?

Authors: Paul Lee, Priya Nair, John A. Eisman, Jacqueline R. Center

Published in: Intensive Care Medicine | Issue 12/2009

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Abstract

The association between vitamin D deficiency and chronic illness is well-known. Vitamin D deficiency has been associated with increased mortality in the general population. Despite this knowledge, vitamin D insufficiency is seldom considered and rarely replaced adequately, if at all, in critically ill patients in intensive care. We present a hypothetic model demonstrating how vitamin D deficiency may be an unrecognized contributor to adverse outcome in intensive care patients.
Literature
1.
go back to reference Lee P, Milliken S, Center JR (2008) Hypocalcaemic cardiac failure post BMT secondary to unrecognized vitamin D deficiency. Bone Marrow Transplant 42:363–364CrossRefPubMed Lee P, Milliken S, Center JR (2008) Hypocalcaemic cardiac failure post BMT secondary to unrecognized vitamin D deficiency. Bone Marrow Transplant 42:363–364CrossRefPubMed
2.
go back to reference Lee P, Samaras K, Glanville A, Center JR (2009) Transplant recipients on the edge of the hypocalcaemia abyss. J Heart Lung Transplant 28:93–95CrossRefPubMed Lee P, Samaras K, Glanville A, Center JR (2009) Transplant recipients on the edge of the hypocalcaemia abyss. J Heart Lung Transplant 28:93–95CrossRefPubMed
3.
go back to reference Lee P, Eisman A, Center JR (2009) Vitamin D deficiency in critically ill patients. N Engl J Med 30:1912–1914CrossRef Lee P, Eisman A, Center JR (2009) Vitamin D deficiency in critically ill patients. N Engl J Med 30:1912–1914CrossRef
4.
go back to reference Zaloga GP, Chernow B, Cook D, Snyder R, Clapper M, O’Brian JT (1985) Assessment of calcium homeostasis in the critically ill surgical patient. The diagnostic pitfalls of the McLean-Hastings nomogram. Ann Surg 202:587–594CrossRefPubMed Zaloga GP, Chernow B, Cook D, Snyder R, Clapper M, O’Brian JT (1985) Assessment of calcium homeostasis in the critically ill surgical patient. The diagnostic pitfalls of the McLean-Hastings nomogram. Ann Surg 202:587–594CrossRefPubMed
6.
go back to reference Zivin JR, Gooley T, Zager RA, Ryan MJ (2001) Hypocalcemia: a pervasive metabolic abnormality in the critically ill. Am J Kidney Dis 37:689–698CrossRefPubMed Zivin JR, Gooley T, Zager RA, Ryan MJ (2001) Hypocalcemia: a pervasive metabolic abnormality in the critically ill. Am J Kidney Dis 37:689–698CrossRefPubMed
7.
go back to reference Hästbacka J, Pettilä V (2003) Prevalence and predictive value of ionized hypocalcemia among critically ill patients. Acta Anaesthesiol Scand 47:1264–1269CrossRefPubMed Hästbacka J, Pettilä V (2003) Prevalence and predictive value of ionized hypocalcemia among critically ill patients. Acta Anaesthesiol Scand 47:1264–1269CrossRefPubMed
8.
go back to reference Desai TK, Carlson RW, Geheb MA (1988) Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am J Med 84:209–214CrossRefPubMed Desai TK, Carlson RW, Geheb MA (1988) Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am J Med 84:209–214CrossRefPubMed
9.
go back to reference Forsythe RM, Wessel CB, Billiar TR, Angus DC, Rosengart MR (2008) Parenteral calcium for intensive care unit patients. Cochrane Database Syst Rev 8:CD006163 Forsythe RM, Wessel CB, Billiar TR, Angus DC, Rosengart MR (2008) Parenteral calcium for intensive care unit patients. Cochrane Database Syst Rev 8:CD006163
10.
go back to reference Burchard KW, Gann DS, Colliton J, Forster J (1990) Ionized calcium, parathormone, and mortality in critically ill surgical patients. Ann Surg 212:543–549CrossRefPubMed Burchard KW, Gann DS, Colliton J, Forster J (1990) Ionized calcium, parathormone, and mortality in critically ill surgical patients. Ann Surg 212:543–549CrossRefPubMed
11.
go back to reference Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, McGee G (2006) Factors influencing length of stay in the intensive care unit. Am J Crit Care 15:502–509PubMed Gruenberg DA, Shelton W, Rose SL, Rutter AE, Socaris S, McGee G (2006) Factors influencing length of stay in the intensive care unit. Am J Crit Care 15:502–509PubMed
12.
go back to reference Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637CrossRefPubMed Melamed ML, Michos ED, Post W, Astor B (2008) 25-hydroxyvitamin D levels and the risk of mortality in the general population. Arch Intern Med 168:1629–1637CrossRefPubMed
13.
go back to reference Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, Kinkeldei J, Boehm BO, Weihrauch G, Maerz W (2008) Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 168:1340–1349CrossRefPubMed Dobnig H, Pilz S, Scharnagl H, Renner W, Seelhorst U, Wellnitz B, Kinkeldei J, Boehm BO, Weihrauch G, Maerz W (2008) Independent association of low serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 168:1340–1349CrossRefPubMed
14.
go back to reference Mailliez S, Shahapuni I, Lecaque C, Massy ZA, Choukroun G, Fournier A (2008) Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 74:389CrossRefPubMed Mailliez S, Shahapuni I, Lecaque C, Massy ZA, Choukroun G, Fournier A (2008) Vitamin D levels and early mortality among incident hemodialysis patients. Kidney Int 74:389CrossRefPubMed
15.
go back to reference Giovannucci E, Liu Y, Hollis BW, Rimm EB (2008) 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med 168:1174–1180CrossRefPubMed Giovannucci E, Liu Y, Hollis BW, Rimm EB (2008) 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med 168:1174–1180CrossRefPubMed
16.
go back to reference Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, Boehm BO, Dobnig H (2008) Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab 93:3927–3935CrossRefPubMed Pilz S, März W, Wellnitz B, Seelhorst U, Fahrleitner-Pammer A, Dimai HP, Boehm BO, Dobnig H (2008) Association of vitamin D deficiency with heart failure and sudden cardiac death in a large cross-sectional study of patients referred for coronary angiography. J Clin Endocrinol Metab 93:3927–3935CrossRefPubMed
17.
go back to reference Pilz S, Dobnig H, Fischer JE, Wellnitz B, Seelhorst U, Boehm BO, März W (2008) Low vitamin d levels predict stroke in patients referred to coronary angiography. Stroke 39:2611–2613CrossRefPubMed Pilz S, Dobnig H, Fischer JE, Wellnitz B, Seelhorst U, Boehm BO, März W (2008) Low vitamin d levels predict stroke in patients referred to coronary angiography. Stroke 39:2611–2613CrossRefPubMed
18.
19.
go back to reference Nnoaham KE, Clarke A (2008) Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol 37:113–119CrossRefPubMed Nnoaham KE, Clarke A (2008) Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol 37:113–119CrossRefPubMed
20.
go back to reference Pappa HM, Grand RJ, Gordon CM (2006) Report on the vitamin D status of adult and pediatric patients with inflammatory bowel disease and its significance for bone health and disease. Inflamm Bowel Dis 12:1162–1174CrossRefPubMed Pappa HM, Grand RJ, Gordon CM (2006) Report on the vitamin D status of adult and pediatric patients with inflammatory bowel disease and its significance for bone health and disease. Inflamm Bowel Dis 12:1162–1174CrossRefPubMed
21.
go back to reference Kamen DL, Aranow C (2008) The link between vitamin D deficiency and systemic lupus erythematosus. Curr Rheumatol Rep 10:273–280CrossRefPubMed Kamen DL, Aranow C (2008) The link between vitamin D deficiency and systemic lupus erythematosus. Curr Rheumatol Rep 10:273–280CrossRefPubMed
22.
go back to reference Zold E, Szodoray P, Gaal J, Kappelmayer J, Csathy L, Gyimesi E, Zeher M, Szegedi G, Bodolay E (2008) Vitamin D deficiency in undifferentiated connective tissue disease. Arthritis Res Ther 10:R123CrossRefPubMed Zold E, Szodoray P, Gaal J, Kappelmayer J, Csathy L, Gyimesi E, Zeher M, Szegedi G, Bodolay E (2008) Vitamin D deficiency in undifferentiated connective tissue disease. Arthritis Res Ther 10:R123CrossRefPubMed
23.
go back to reference Arnson Y, Amital H, Shoenfeld Y (2007) Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis 66:1137–1142CrossRefPubMed Arnson Y, Amital H, Shoenfeld Y (2007) Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis 66:1137–1142CrossRefPubMed
24.
go back to reference Janssens W, Lehouck A, Carremans C, Bouillon R, Mathieu C, Decramer M (2009) Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med 179:630–636CrossRefPubMed Janssens W, Lehouck A, Carremans C, Bouillon R, Mathieu C, Decramer M (2009) Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med 179:630–636CrossRefPubMed
25.
go back to reference Adorini L, Penna G (2008) Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 4:404–412CrossRefPubMed Adorini L, Penna G (2008) Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 4:404–412CrossRefPubMed
26.
go back to reference Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V (2009) Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med 23:28CrossRef Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR, Tangpricha V (2009) Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med 23:28CrossRef
28.
go back to reference Lowry SF, Goodgame JT Jr, Maher MM, Brennan MF (1978) Parenteral vitamin requirements during intravenous feeding. Am J Clin Nutr 31:2149–2158PubMed Lowry SF, Goodgame JT Jr, Maher MM, Brennan MF (1978) Parenteral vitamin requirements during intravenous feeding. Am J Clin Nutr 31:2149–2158PubMed
29.
go back to reference Nichoalds GE, Meng HC, Caldwell MD (1977) Vitamin requirements in patients receiving total parenteral nutrition. Arch Surg 112:1061–1064PubMed Nichoalds GE, Meng HC, Caldwell MD (1977) Vitamin requirements in patients receiving total parenteral nutrition. Arch Surg 112:1061–1064PubMed
30.
go back to reference Bradley JA, King RF, Schorah CJ, Hill GL (1978) Vitamins in intravenous feeding: a study of water-soluble vitamins and folate in critically ill patients receiving intravenous nutrition. Br J Surg 65:492–494CrossRefPubMed Bradley JA, King RF, Schorah CJ, Hill GL (1978) Vitamins in intravenous feeding: a study of water-soluble vitamins and folate in critically ill patients receiving intravenous nutrition. Br J Surg 65:492–494CrossRefPubMed
31.
go back to reference Kirkemo AK, Burt ME, Brennan MF (1982) Serum vitamin level maintenance in cancer patients on total parenteral nutrition. Am J Clin Nutr 35:1003–1009PubMed Kirkemo AK, Burt ME, Brennan MF (1982) Serum vitamin level maintenance in cancer patients on total parenteral nutrition. Am J Clin Nutr 35:1003–1009PubMed
32.
go back to reference Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R (2003) Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab 88:4623–4632CrossRefPubMed Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R (2003) Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab 88:4623–4632CrossRefPubMed
33.
go back to reference Lee P, Greenfield JR, Seibel MJ, Eisman JA, Center JR (2009) Adequacy of vitamin D replacement is dependent on body mass index. Am J Med (in press) Lee P, Greenfield JR, Seibel MJ, Eisman JA, Center JR (2009) Adequacy of vitamin D replacement is dependent on body mass index. Am J Med (in press)
34.
go back to reference Hollander JM, Mechanick JI (2009) Bisphosphonates and metabolic bone disease in the ICU. Curr Opin Clin Nutr Metab Care 12:190–195CrossRefPubMed Hollander JM, Mechanick JI (2009) Bisphosphonates and metabolic bone disease in the ICU. Curr Opin Clin Nutr Metab Care 12:190–195CrossRefPubMed
35.
go back to reference Oberhoffer M, Vogelsang H, Russwurm S, Hartung T, Reinhart K (1999) Outcome prediction by traditional and new markers of inflammation in patients with sepsis. Clin Chem Lab Med 37:363–368CrossRefPubMed Oberhoffer M, Vogelsang H, Russwurm S, Hartung T, Reinhart K (1999) Outcome prediction by traditional and new markers of inflammation in patients with sepsis. Clin Chem Lab Med 37:363–368CrossRefPubMed
36.
go back to reference Arbarth S, Holeckova K, Froidevaux C et al (2001) Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 164:396–402 Arbarth S, Holeckova K, Froidevaux C et al (2001) Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 164:396–402
37.
go back to reference Pettilä V, Pentti J, Pettilä M et al (2002) Predictive value of antithrombin III and serum C-reactive protein concentration in critically ill patients with suspected sepsis. Crit Care Med 30:271–275CrossRefPubMed Pettilä V, Pentti J, Pettilä M et al (2002) Predictive value of antithrombin III and serum C-reactive protein concentration in critically ill patients with suspected sepsis. Crit Care Med 30:271–275CrossRefPubMed
Metadata
Title
Vitamin D deficiency in the intensive care unit: an invisible accomplice to morbidity and mortality?
Authors
Paul Lee
Priya Nair
John A. Eisman
Jacqueline R. Center
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 12/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1642-x

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