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