Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa.

Research output: Contribution to journalReview articlepeer-review

Authors

  • Karin Amrein
  • Alja Papinutti
  • Erwin Mathew
  • Greisa Vila
  • Dhruv Parekh

Colleges, School and Institutes

Abstract

The prevalence of vitamin D deficiency in intensive care units ranges typically between 40 and 70%. There are many reasons for being or becoming deficient in the ICU. Hepatic, parathyroid and renal dysfunction additionally increases the risk for developing vitamin D deficiency. Moreover, therapeutic interventions like fluid resuscitation, dialysis, surgery, extracorporeal membrane oxygenation, cardiopulmonary bypass and plasma exchange may significantly reduce vitamin D levels. Many observational studies have consistently shown an association between low vitamin D levels and poor clinical outcomes in critically ill adults and children, including excess mortality and morbidity such as acute kidney injury, acute respiratory failure, duration of mechanical ventilation and sepsis. It is biologically plausible that vitamin D deficiency is an important and
modifiable contributor to poor prognosis during and after critical illness. Although vitamin D supplementation is inexpensive, simple and has an excellent safety profile, testing for and treating vitamin D deficiency is currently not routinely performed. Overall, less than 800 patients have been included in RCTs worldwide, but the available data suggest that high-dose vitamin D supplementation could be beneficial. Two large RCTs in Europe and the United States, together aiming to recruit >5000 patients, have started in 2017, and will greatly improve our knowledge in this field. This review aims to summarize current knowledge in this interdisciplinary topic and give an outlook on its
highly dynamic future.

Details

Original languageEnglish
Pages (from-to)R304–R315
Number of pages12
JournalEndocrine Connections
Volume7
Issue number12
Early online date5 Oct 2018
Publication statusPublished - Dec 2018