Changes in vitamin D metabolites at the time of critical illness and 6 months later-A prospective observational study

Gudrun Maria Jonsdottir; Runar Bragi Kvaran; Sigurbjorg Johanna Skarphedinsdottir; Sigurbergur Karason; Diane Krueger; Douglas B Coursin; Neil Binkley; Andrew N Hoofnagle; Kirk Hogan; Gisli Heimir Sigurdsson; Martin Ingi Sigurdsson

doi:10.1111/aas.14137

Changes in vitamin D metabolites at the time of critical illness and 6 months later-A prospective observational study

Acta Anaesthesiol Scand. 2022 Nov;66(10):1202-1210. doi: 10.1111/aas.14137. Epub 2022 Aug 29.

Authors

Affiliations

¹ Department of Anesthesia and Intensive Care Medicine, Operational Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
² Department of Anesthesiology and Critical Care, Yale New Haven Hospital, New Haven, Connecticut, USA.
³ Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
⁵ Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁶ Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
⁷ Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA.
⁸ Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.

PMID: 36054671
DOI: 10.1111/aas.14137

Abstract

Background: Despite multiple studies suggesting that low 25(OH)D-vitamin levels are associated with worse outcomes in critically ill individuals, attempts to mitigate the outcomes by fixed dose enteral supplementation unguided by baseline or target blood levels have been unsuccessful. Since a single measurement of 25(OH)D may not optimally reflect an individual's vitamin D status, we studied the plasma concentration of different vitamin D metabolites and their recovery during and following resolution of acute critical illness.

Methods: A prospective observational study including patients 18 years and older admitted to a mixed medical-surgical ICU in Reykjavik, Iceland, located at a high-northern altitude (64° N). Vitamin D metabolites were measured at three timepoints; On admission (S1), 3-5 days following admission (S2) and after recovery from acute illness (median 178 days) (S3). Concentrations of total 25(OH)D-vitamin, cholecalciferol (D₃ ), total 24,25(OH)D-vitamin, vitamin D binding protein (VDBP) were measured with LC-tandem mass spectrometry (LC-MS/MS) and free 25-(OH)D was measured with enzyme-linked immunosorbent assay.

Results: Most individuals were vitamin D deficient when assessed during critical illness, with 25(OH)D-vitamin levels under 30 ng/ml for 37/40 individuals at timepoint S1 and 34/38 at S2. After recovery, 18/30 patients were deficient at S3. Levels of all vitamin D metabolites measured were low during critical illness but rose substantially following resolution of acute illness. No strong correlation was found between markers of acute illness severity or duration and resolution of vitamin D metabolites in the interval between acute illness and recovery.

Conclusions: In critically ill patients, levels of multiple vitamin D metabolites are low but substantial recovery occurs following resolution of acute illness. It is unclear whether a single metabolite is sufficient to assess vitamin D status of critically ill patients and guide potential supplementation.

Keywords: ICU; metabolism; nutrition; vitamin D.

Publication types

Observational Study

MeSH terms

Acute Disease
Cholecalciferol
Chromatography, Liquid
Critical Illness*
Humans
Tandem Mass Spectrometry
Vitamin D
Vitamin D Deficiency*
Vitamin D-Binding Protein
Vitamins / analysis

Substances

Vitamin D-Binding Protein
Vitamin D
Cholecalciferol
Vitamins