Intensive Care Medicine

, Volume 39, Issue 2, pp 267–274 | Cite as

Significant perturbation of vitamin D–parathyroid–calcium axis and adverse clinical outcomes in critically ill patients

  • Priya NairEmail author
  • Paul Lee
  • Claire Reynolds
  • Nguyen Dinh Nguyen
  • John Myburgh
  • John A. Eisman
  • Jacqueline R. Center



A prospective multicentre cohort study was conducted to determine the prevalence of hypovitaminosis D in adult critically ill patients, to characterize alterations in the parathyroid hormone (PTH)–vitamin D–calcium axis and to explore associations between hypovitaminosis D and adverse clinical outcomes.


Demographic, disease severity scores and clinical outcome data were collected in 100 consecutive patients with expected intensive care unit (ICU) admission of at least 2 days. Levels of 25-hydroxyvitamin D (25-OH-D), 1,25-dihydroxyvitamin D (1,25-(OH)2-D), PTH and ionized calcium were measured on days 1, 3 and on day 7 or ICU discharge.


The prevalence of vitamin D insufficiency (25 nmol/L ≤ 25-OH-D ≤ 50 nmol/L) and deficiency (25-OH-D < 25 nmol/L) were 54 and 24 %, respectively, and levels did not recover during ICU stay. Admission 25-OH-D levels correlated with 1,25-(OH)2-D (R = 0.61, p = 0.001), Simplified Acute Physiology Score (SAPS-II) (R = −0.3, p = 0.01), Acute Physiology and Chronic Health Evaluation (APACHE-II) scores (R = −0.2, p = 0.05), but not calcium (R = 0.16, p = 0.11) or PTH (R = −0.11, p = 0.31) levels. Vitamin D deficiency was associated with fewer hospital-free days, OR 3.15 (1.18–8.43) in univariate analysis. Secondary hyperparathyroidism (PTH > 7 pmol/L) was observed in 37.5 % of hypocalcaemic and 32.5 % of vitamin D insufficient/deficient patients, and was associated with higher SAPS-II [43 (31.3–60) vs. 36 (30–43), p = 0.03].


Hypovitaminosis D and secondary hyperparathyroidism are highly prevalent in critically ill patients. Low vitamin D status persists during ICU stay and is associated with worse disease severity and fewer hospital-free days.


Vitamin D deficiency Endocrine disorders Hypocalcaemia Secondary hyperparathyroidism 



We gratefully acknowledge the contribution of David Gattas, Dorrilyn Rajabhandari, Heidi Buhr (Royal Prince Alfred Hospital, Sydney), Manoj Saxena, Rebecca Sidoli and Deborah Inskip (St George Hospital, Sydney) to patient enrolment and data collection.

Supplementary material

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Supplementary material 1 (DOC 13 kb)
134_2012_2713_MOESM2_ESM.doc (48 kb)
Supplementary material 2 (DOC 14 kb)
134_2012_2713_MOESM3_ESM.doc (30 kb)
Supplementary material 3 (DOC 11 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Priya Nair
    • 1
    • 2
    • 6
    Email author
  • Paul Lee
    • 2
    • 4
    • 5
  • Claire Reynolds
    • 1
  • Nguyen Dinh Nguyen
    • 2
  • John Myburgh
    • 3
    • 6
    • 7
  • John A. Eisman
    • 2
    • 3
    • 8
  • Jacqueline R. Center
    • 2
    • 3
    • 8
  1. 1.Intensive Care UnitSt Vincents HospitalSydneyAustralia
  2. 2.Bone and Mineral Research ProgrammeGarvan Institute of Medical ResearchSydneyAustralia
  3. 3.Faculty of MedicineUniversity of New South WalesSydneyAustralia
  4. 4.Department of Diabetes and EndocrinologyPrincess Alexandra HospitalBrisbaneAustralia
  5. 5.School of MedicineUniversity of QueenslandBrisbaneAustralia
  6. 6.Critical Care and Trauma DivisionThe George Institute for Global HealthSydneyAustralia
  7. 7.Intensive Care UnitSt George HospitalSydneyAustralia
  8. 8.Department of EndocrinologySt Vincents HospitalSydneyAustralia

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