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Pirdastan S, Mahdavi Roshan M, Mobayen M, Asadzadegan R, Ebrahim Ghafari M, Mazhari SA, Sadeghi M, Bagheri Toolaroud P, Alizadeh Otaghvar H. Effect of vitamin D on clinical outcomes in patients with thermal injury. Int Wound J 2024; 21:e14641. [PMID: 38379253 PMCID: PMC10828730 DOI: 10.1111/iwj.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 02/22/2024] Open
Abstract
Evaluating complications and mortality risks in burn patients is crucial for effective treatment planning and improving survival rates. This study investigated the relationship between the serum vitamin D level and the clinical outcomes of adult burns patients. This was a prospective cohort of adult patients hospitalized due to thermal burns at a burn centre in the north of Iran. Based on the level of 25 hydroxyvitamin D measured upon admission, patients were divided into two groups of patients with sufficient 25 hydroxyvitamin D level and insufficient 25 hydroxyvitamin D level. Descriptive statistics were used for baseline demographics. Univariate analysis was conducted using Mann-Whitney U, Chi-square, independent samples, and Fisher's exact tests. A multivariate logistic regression was performed to adjust for the effects of confounding variables. Statistical analyses were conducted using SPSS 28.0 software. A total of 220 patients were included in the study. The average total body surface area burned was 30.52 ± 9.34. Patients with insufficient vitamin D levels had longer hospital stays (12.53 vs. 11.45) and longer stays in the intensive care unit (ICU) (3.32 vs. 2.40) than those with appropriate vitamin D levels. Participants with insufficient vitamin D levels exhibited a numerically higher incidence of infections than those with adequate levels (p < 0.05). The multivariate regression found that vitamin D deficiency levels were associated with increased infection rates and prolonged hospital stay. This study suggests that vitamin D deficiency is a significant risk factor for adverse clinical outcomes in burn patients. Further research is needed to confirm these associations and to explore potential interventions to optimize vitamin D status in this patient population.
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Affiliation(s)
- Sepide Pirdastan
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Marjan Mahdavi Roshan
- Cardiovascular Disease Research Center, Department of Cardiology, Heshmat Hospital, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Reza Asadzadegan
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Mohammad Ebrahim Ghafari
- Department of Biostatistics and Epidemiology, Faculty of HealthQom University of Medical SciencesQomIran
| | | | - Mahsa Sadeghi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Parissa Bagheri Toolaroud
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Health Information Management Research CenterKashan University of Medical SciencesKashanIran
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Holmes WL, Maish GO, Minard G, Croce MA, Dickerson RN. Hypercalcemia Without Hypervitaminosis D During Cholecalciferol Supplementation in Critically Ill Patients. Nutr Clin Pract 2019; 35:933-941. [PMID: 31605425 DOI: 10.1002/ncp.10407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Vitamin D deficiency during critical illness has been associated with worsened outcomes. Because most critically ill patients with severe traumatic injuries are vitamin D deficient, we investigated the efficacy and safety of cholecalciferol therapy for these patients. METHODS Fifty-three patients (>17 years of age) admitted to the trauma intensive care unit who had a serum 25-hydroxy vitamin D (25-OH vit D) concentration <20 ng/mL were given 10,000 IU of cholecalciferol daily. Efficacy was defined as achievement of a 25-OH vit D of 30-79.9 ng/mL. Safety was evaluated by the presence of hypercalcemia (serum ionized calcium [iCa] >1.32 mmol/L) or hypervitaminosis D (25-OH vit D >79.9 nmol/L). Patients were monitored for 2 weeks during cholecalciferol therapy. RESULTS Twenty-four patients (45%) achieved target 25-OH vit D. No patients experienced hypervitaminosis D. Hypercalcemia occurred in 40% (n = 21) of patients; 2 patients experienced an iCa >1.49 nmol/L. 25-OH vit D was significantly greater for those who developed hypercalcemia (37.2 + 11.2 vs 28.4 + 5.6 ng/mL, respectively, P < 0.001) by the second week of cholecalciferol. Of 24 patients who achieved target 25-OH vit D, 14 (58%) experienced hypercalcemia in contrast to 24% of patients (7 out of 29) who did not achieve target 25-OH vit D (P = 0.024). CONCLUSIONS Cholecalciferol normalized serum 25-OH vit D concentrations in less than half of patients yet was associated with a substantial proportion of patients with hypercalcemia without hypervitaminosis D.
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Affiliation(s)
- Whitney L Holmes
- Department of Pharmacy, Regional One Health, Memphis, Tennessee, USA
| | - George O Maish
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Gayle Minard
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Martin A Croce
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Roland N Dickerson
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Abstract
Recently, many studies have demonstrated pleotropic effects of vitamin D, including immune modulation and cardiovascular system activity. Sufficient vitamin D concentrations and supplementation of vitamin D may be of benefit in burn-injured patients. Low 25(OH)D has been observed in nearly all pediatric and most adult burn patients. Vitamin D has primarily been studied in pediatric burn patients, focusing on bone marker measurements and the incidence of fractures. The preferred vitamin D dose, formulation, and route of administration remain unknown, and there is limited data on the impact of vitamin D status on clinical outcomes. Further research should focus on determining optimal monitoring strategies, supplementation regimens and clinical outcomes like mortality, length of stay and incidence of sepsis.
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Abdel-Hady H, Yahia S, Megahed A, Mosbah A, Seif B, Nageh E, Bhattacharjee I, Aly H. Mediators in Preterm Infants With Late-onset Sepsis: A Randomized Controlled Trial. J Pediatr Gastroenterol Nutr 2019; 68:578-584. [PMID: 30896608 DOI: 10.1097/mpg.0000000000002238] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate biochemical and clinical effects of 2 different doses of vitamin D supplementation in preterm infants with late-onset sepsis (LOS). STUDY DESIGN A double blinded randomized controlled stratified trial included preterm infants with gestational age (GA) ≥28 weeks with LOS. Subjects were randomly assigned to receive 400 or 800 IU/day of vitamin D3. Serum concentrations of 25(OH)D, TNF-α, and IL-6 were measured at enrollment, 7 days after vitamin D supplementation, and at 40 weeks of postmenstrual age (PMA). Short-term outcomes and growth parameters were assessed. RESULTS A total of 50 infants were enrolled, 25 in each group. Seventy-six percentage of enrolled infants were vitamin D-deficient at enrollment in both groups whereas only one infant in the 400 IU and none in the 800 IU group remained deficient at 40 week's PMA; vitamin D concentrations at 40 weeks PMA were 54.8 ± 35.1 and 67.4 ± 37.1 ng/mL, respectively, P = 0.01). None of the infants enrolled in the study had signs of vitamin D toxicity. Serum pro-inflammatory cytokines IL-6 and TNF- α concentrations decreased at 1 week and at discharge in both groups without differences between groups. The 2 groups did not differ in anthropometric measurements, duration of oxygen and respiratory support, duration of antimicrobial use, length of hospital stay, and mortality. CONCLUSIONS A dose of 400 IU of vitamin D was adequate to treat vitamin D deficiency in the majority of premature infants with LOS. The 2 dosing regimens did not differ in clinical or biochemical changes.
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Affiliation(s)
| | | | | | - Abeer Mosbah
- Department of Clinical Pathology, Faculty of Medicine-Mansoura University, Mansoura, Egypt
| | | | | | | | - Hany Aly
- Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH
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Obesity attenuates serum 25-hydroxyvitamin D response to cholecalciferol therapy in critically ill patients. Nutrition 2019; 63-64:120-125. [PMID: 30939386 DOI: 10.1016/j.nut.2019.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/20/2019] [Accepted: 01/25/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The presence of obesity may confound cholecalciferol dosing in vitamin D-deficient patients owing to potentially decreased bioavailability. The aim of this retrospective study was to evaluate cholecalciferol therapy in vitamin D-deficient, critically ill trauma patients with and without obesity. METHODS Adult patients with severe traumatic injuries who had a serum 25-hydroxyvitamin D (25-OH vit D) <50nmol/L were prescribed 10 000 IU of liquid cholecalciferol daily. Efficacy was defined as achievement of a 25-OH vit D of 75 to 200nmol/L. Safety was evaluated by the presence of hypercalcemia (serum ionized calcium >1.32 mmol/L). Fifty-three patients (18 obese, 35 non-obese) were identified for study. RESULTS Despite similar baseline concentrations (36 ± 7 versus 37 ± 7 nmol/L; P = NS), 25-OH vit D response was attenuated for those with obesity after 1 and 2 wk of cholecalciferol therapy (51 ± 18 versus 66 ± 27nmol/L, P < 0.01; 68 ± 19 versus 92 ± 25nmol/L, P < 0.01, respectively). Patients with obesity also tended to experience less hypercalcemia (22% versus 49% of patients, respectively) post-cholecalciferol therapy. CONCLUSION Obesity alters the response to cholecalciferol therapy in critically ill patients with severe traumatic injuries.
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Vitamin D supplementation in the critically ill: A systematic review and meta-analysis. Clin Nutr 2018; 37:1238-1246. [DOI: 10.1016/j.clnu.2017.05.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 04/15/2017] [Accepted: 05/06/2017] [Indexed: 02/06/2023]
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Trongtrakul K, Feemuchang C. Prevalence and association of vitamin D deficiency and mortality in patients with severe sepsis. Int J Gen Med 2017; 10:415-421. [PMID: 29184435 PMCID: PMC5685096 DOI: 10.2147/ijgm.s147561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Vitamin D is a steroid prohormone that regulates body calcium and phosphate metabolism. Recent studies have shown an association between low vitamin D status and high mortality in patients admitted to intensive care units. To date, there are limited data available specifically about severely septic patients in medical units. Objectives To determine the prevalence of vitamin D deficiency in severely septic patients and its clinical outcomes, including mortality rate. Methods A prospective observational study was conducted to investigate the prevalence of vitamin D deficiency and its association with 30-day mortality in patients with severe sepsis. Patients admitted to medical wards at our hospital between November 2014 and March 2015 were included in the study. A 25-hydroxyvitamin D level <20 ng/mL was defined as vitamin D deficiency, and <12 ng/mL as severe deficiency. For an association analysis, the patients were grouped into deficient versus not deficient and severely deficient versus not severely deficient. Results One hundred and ten eligible patients were enrolled. A total of 83 patients (75%) had vitamin D deficiency and 42 (38%) had severe deficiency. Despite an insignificant higher 30-day hospital mortality rate in vitamin D deficient versus non-deficient groups (16% vs 4%, p=0.18), the differences were significant between the severely deficient versus non-severe groups (23% vs 4%, p=0.02). The odds ratio of the 30-day mortality rate was 4.83 (95% confidence interval [CI], 0.60–38.77, p=0.14) for vitamin D deficiency and 7.69 (95% CI, 2.00–29.55, p=0.003) for severe deficiency. Conclusion The prevalence of vitamin D deficiency was very high in three-quarters of patients with severe sepsis. A significant higher mortality rate was observed, particularly in patients with severe vitamin D deficiency.
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Affiliation(s)
| | - Chookiat Feemuchang
- Internal Medicine Department, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Rao Z, Zhang N, Xu N, Pan Y, Xiao M, Wu J, Zhou H, Yang S, Chen Y. 1,25-Dihydroxyvitamin D Inhibits LPS-Induced High-Mobility Group Box 1 (HMGB1) Secretion via Targeting the NF-E2-Related Factor 2-Hemeoxygenase-1-HMGB1 Pathway in Macrophages. Front Immunol 2017; 8:1308. [PMID: 29085368 PMCID: PMC5650703 DOI: 10.3389/fimmu.2017.01308] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 09/27/2017] [Indexed: 12/30/2022] Open
Abstract
1,25-Dihydroxyvitamin D [1,25(OH)2D3] is recognized as a key mediator of inflammatory diseases, including sepsis. Clinical studies demonstrate that 1,25 (OH)2D3 protects patients from sepsis, but clinical treatment with 1,25(OH)2D3 is rare. In this study, we report that 1,25(OH)2D3 treatment has beneficial effects and improves the survival rate in LPS-induced mouse sepsis model by blocking the secretion of high-mobility group box 1 (HMGB1), a key late regulator of sepsis. LPS-induced HMGB1 secretion is attenuated by 1,25(OH)2D3via blocking HMGB1 translocation from the nucleus to the cytoplasm in macrophages. 1,25(OH)2D3 can induce the expression of hemeoxygenase-1 (HO-1), which is essential for blocking HMBG1 nuclear translocation and its secretion. When siHO-1 or an HO-1 inhibitor are used, the effect of 1,25(OH)2D3 on inhibition of HMGB1 secretion is suppressed. Considering that HO-1 is a downstream gene of NF-E2-related factor 2 (Nrf2), we further confirm that Nrf2 activation can be activated by 1,25(OH)2D3 upon LPS exposure. Together, we provide evidence that 1,25(OH)2D3 attenuates LPS-induced HMGB1 secretion via the Nrf2/HO-1 pathway in macrophages.
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Affiliation(s)
- Zebing Rao
- Department of Immunology, Nanjing Medical University, Nanjing, China.,Key Laboratory of Antibody Techniques of Ministry of Health, Nanjing Medical University, Nanjing, China
| | - Na Zhang
- Department of Immunology, Nanjing Medical University, Nanjing, China.,Key Laboratory of Antibody Techniques of Ministry of Health, Nanjing Medical University, Nanjing, China
| | - Ning Xu
- Department of Pathology, Nanjing Medical University, Nanjing, China
| | - Ying Pan
- Department of Immunology, Nanjing Medical University, Nanjing, China.,Key Laboratory of Antibody Techniques of Ministry of Health, Nanjing Medical University, Nanjing, China
| | - Mengjun Xiao
- Department of Immunology, Nanjing Medical University, Nanjing, China.,Key Laboratory of Antibody Techniques of Ministry of Health, Nanjing Medical University, Nanjing, China
| | - Junxian Wu
- Department of Immunology, Nanjing Medical University, Nanjing, China.,Key Laboratory of Antibody Techniques of Ministry of Health, Nanjing Medical University, Nanjing, China
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, Nanjing, China
| | - Shuo Yang
- Department of Immunology, Nanjing Medical University, Nanjing, China.,Key Laboratory of Antibody Techniques of Ministry of Health, Nanjing Medical University, Nanjing, China
| | - Yunzi Chen
- Department of Immunology, Nanjing Medical University, Nanjing, China.,Key Laboratory of Antibody Techniques of Ministry of Health, Nanjing Medical University, Nanjing, China.,Medical Centre for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Dickerson RN, Van Cleve JR, Swanson JM, Maish GO, Minard G, Croce MA, Brown RO. Vitamin D deficiency in critically ill patients with traumatic injuries. BURNS & TRAUMA 2016; 4:28. [PMID: 27833924 PMCID: PMC5066285 DOI: 10.1186/s41038-016-0054-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/30/2016] [Indexed: 11/10/2022]
Abstract
Background Vitamin D depletion has been associated with increased rate of infections, lengthened hospital stay, and worsened mortality for critically ill patients. The purpose of this study was to evaluate the prevalence and variables associated with vitamin D deficiency in critically ill patients with severe traumatic injuries. Methods Critically ill adult patients admitted to the trauma intensive care unit (ICU) between June 2013 and June 2014, referred to the nutrition support service for enteral or parenteral nutrition, and had a serum 25-hydroxyvitamin D (25-OH vitamin D) concentration determination were retrospectively evaluated. Patients were stratified as vitamin D sufficient, insufficient, deficient, or severely deficient based on a 25-OH vitamin D concentration of 30–80, 20–29.9, 13.1–19.9, and ≤13 ng/mL, respectively. Results One hundred and twenty-one patients out of 158 (76 %) patients were vitamin D deficient or severely deficient. Thirty-one patients (20 %) were insufficient and 6 (4 %) had a normal 25-OH vitamin D concentration. 25-OH vitamin D was determined 7.5 ± 5.1 days after ICU admission. African-Americans had a greater proportion of patients with deficiency or severe deficiency compared to other races (91 versus 64 %, P = 0.02). Penetrating gunshot or knife stab injury, African-American race, and obesity (elevated body mass index) were significantly associated with vitamin D deficiency or severe deficiency: OR 9.23 (1.13, 75.40), 4.0 (1.4, 11.58), and 1.12 (1.03, 1.23), P < 0.05, respectively. Conclusions The majority of critically ill patients with traumatic injuries exhibit vitamin D deficiency or severe deficiency. Penetrating injuries, African-American race, and obesity are significant risk factors for deficiency. Severity of injury, extent of inflammation (elevated C-reactive protein concentration), or hospital admission during the winter season did not significantly influence the prevalence of vitamin D deficiency.
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Affiliation(s)
- Roland N Dickerson
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Suite 345, Memphis, 38163 TN USA
| | - Jonathan R Van Cleve
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Suite 345, Memphis, 38163 TN USA
| | - Joseph M Swanson
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Suite 345, Memphis, 38163 TN USA
| | - George O Maish
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, 2nd Floor, Memphis, 38163 TN USA
| | - Gayle Minard
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, 2nd Floor, Memphis, 38163 TN USA
| | - Martin A Croce
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, 2nd Floor, Memphis, 38163 TN USA
| | - Rex O Brown
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Suite 345, Memphis, 38163 TN USA
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High Dose Vitamin D Administration in Ventilated Intensive Care Unit Patients: A Pilot Double Blind Randomized Controlled Trial. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2016; 4:59-65. [PMID: 27419080 PMCID: PMC4939707 DOI: 10.1016/j.jcte.2016.04.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
First double blind RCT of vitamin D therapy in mechanically ventilated patients. Treatment with placebo, 250,000 IU or 500,000 IU enteral vitamin D3 was well tolerated. Significant increase in plasma 25(OH)D from baseline to day 7. Significant decrease in hospital length of stay for vitamin D3 treated subjects. No change in plasma LL-37 according to treatment group.
Background There is a high prevalence of vitamin D deficiency in the critically ill patient population. Several intensive care unit studies have demonstrated an association between vitamin D deficiency [25-hydroxyvitamin D (25(OH)D) < 20 ng/mL] and increased hospital length of stay (LOS), readmission rate, sepsis and mortality. Material and Methods Pilot, double blind randomized control trial conducted on mechanically ventilated adult ICU patients. Subjects were administered either placebo, 50,000 IU vitamin D3 or 100,000 IU vitamin D3 daily for 5 consecutive days enterally (total vitamin D3 dose = 250,000 IU or 500,000 IU, respectively). The primary outcome was plasma 25(OH)D concentration 7 days after oral administration of study drug. Secondary outcomes were plasma levels of the antimicrobial peptide cathelicidin (LL37), hospital LOS, SOFA score, duration of mechanical ventilation, hospital mortality, mortality at 12 weeks, and hospital acquired infection. Results A total of 31 subjects were enrolled with 13 (43%) being vitamin D deficient at entry (25(OH)D levels < 20 ng/mL). The 250,000 IU and 500,000 IU vitamin D3 regimens each resulted in a significant increase in mean plasma 25(OH)D concentrations from baseline to day 7; values rose to 45.7 ± 19.6 ng/mL and 55.2 ± 14.4 ng/mL, respectively, compared to essentially no change in the placebo group (21 ± 11.2 ng/mL), p < 0.001. There was a significant decrease in hospital length of stay over time in the 250,000 IU and the 500,000 IU vitamin D3 group, compared to the placebo group (25 ± 14 and 18 ± 11 days compared to 36 ± 19 days, respectively; p = 0.03). There was no statically significant change in plasma LL-37 concentrations or other clinical outcomes by group over time. Conclusions In this pilot study, high-dose vitamin D3 safely increased plasma 25(OH)D concentrations into the sufficient range and was associated with decreased hospital length of stay without altering other clinical outcomes.
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Kamr AM, Dembek KA, Reed SM, Slovis NM, Zaghawa AA, Rosol TJ, Toribio RE. Vitamin D Metabolites and Their Association with Calcium, Phosphorus, and PTH Concentrations, Severity of Illness, and Mortality in Hospitalized Equine Neonates. PLoS One 2015; 10:e0127684. [PMID: 26046642 PMCID: PMC4457534 DOI: 10.1371/journal.pone.0127684] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/17/2015] [Indexed: 12/31/2022] Open
Abstract
Background Hypocalcemia is a frequent abnormality that has been associated with disease severity and outcome in hospitalized foals. However, the pathogenesis of equine neonatal hypocalcemia is poorly understood. Hypovitaminosis D in critically ill people has been linked to hypocalcemia and mortality; however, information on vitamin D metabolites and their association with clinical findings and outcome in critically ill foals is lacking. The goal of this study was to determine the prevalence of vitamin D deficiency (hypovitaminosis D) and its association with serum calcium, phosphorus, and parathyroid hormone (PTH) concentrations, disease severity, and mortality in hospitalized newborn foals. Methods and Results One hundred newborn foals ≤72 hours old divided into hospitalized (n = 83; 59 septic, 24 sick non-septic [SNS]) and healthy (n = 17) groups were included. Blood samples were collected on admission to measure serum 25-hydroxyvitamin D3 [25(OH)D3], 1,25-dihydroxyvitamin D3 [1,25(OH) 2D3], and PTH concentrations. Data were analyzed by nonparametric methods and univariate logistic regression. The prevalence of hypovitaminosis D [defined as 25(OH)D3 <9.51 ng/mL] was 63% for hospitalized, 64% for septic, and 63% for SNS foals. Serum 25(OH)D3 and 1,25(OH) 2D3 concentrations were significantly lower in septic and SNS compared to healthy foals (P<0.0001; P = 0.037). Septic foals had significantly lower calcium and higher phosphorus and PTH concentrations than healthy and SNS foals (P<0.05). In hospitalized and septic foals, low 1,25(OH)2D3 concentrations were associated with increased PTH but not with calcium or phosphorus concentrations. Septic foals with 25(OH)D3 <9.51 ng/mL and 1,25(OH) 2D3 <7.09 pmol/L were more likely to die (OR=3.62; 95% CI = 1.1-12.40; OR = 5.41; 95% CI = 1.19-24.52, respectively). Conclusions Low 25(OH)D3 and 1,25(OH)2D3 concentrations are associated with disease severity and mortality in hospitalized foals. Vitamin D deficiency may contribute to a pro-inflammatory state in equine perinatal diseases. Hypocalcemia and hyperphosphatemia together with decreased 1,25(OH)2D3 but increased PTH concentrations in septic foals indicates that PTH resistance may be associated with the development of these abnormalities.
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Affiliation(s)
- Ahmed M. Kamr
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - Katarzyna A. Dembek
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Stephen M. Reed
- Rood and Riddle Equine Hospital, Lexington, Kentucky, United States of America
| | - Nathan M. Slovis
- Hagyard Equine Medical Institute, Lexington, Kentucky, United States of America
| | - Ahmed A. Zaghawa
- Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - Thomas J. Rosol
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Ramiro E. Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Dickerson RN, Berry SC, Ziebarth JD, Swanson JM, Maish GO, Minard G, Brown RO. Dose-response effect of ergocalciferol therapy on serum 25-hydroxyvitamin D concentration during critical illness. Nutrition 2015. [PMID: 26213135 DOI: 10.1016/j.nut.2015.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the dose-response relationship between ergocalciferol therapy and serum 25-hydroxyvitamin D concentrations in enterally fed, critically ill patients with traumatic injuries. METHODS A retrospective cohort of critically ill patients with traumatic injuries and vitamin D deficiency (25-OH vitamin D <50 nmol/L) were given either 50 000 IU of liquid ergocalciferol weekly, twice weekly, or three times weekly while in the intensive care unit (ICU). Serum 25-OH vitamin D and ionized calcium concentrations were monitored weekly. Ergocalciferol therapy was stopped when the serum 25-OH vitamin D was >75 nmol/L, if the patient experienced hypercalcemia (ionized calcium >1.34 mmol/L), when the patient was discharged from the ICU, or if enteral nutrition was discontinued. RESULTS Sixty-five patients (16, 18, and 31 per dosage group) were examined. One (6%), two (11%), and eight (26%) patients achieved normal 25-OH vitamin D concentrations after 2 to 4 wk of ergocalciferol therapy for each dosage group, respectively (P < 0.001). Serum 25-OH vitamin D concentrations improved from 36 ± 6, 40 ± 7, and 37 ± 6 nmol/L to 50 ± 15, 54 ± 21, and 62 ± 17 nmol/L, respectively, after 2 wk of ergocalciferol therapy (P < 0.001) Two (13%), one (6%), and seven (23%) patients developed hypercalcemia for each dosage group, respectively (P = NS). CONCLUSIONS Ergocalciferol therapy improved baseline serum 25-OH vitamin D concentrations but was inadequate for consistently achieving normal serum concentrations of 25-OH vitamin D during critical illness. The trend in increasing appearance of mild hypercalcemia for the highest dosage group is concerning.
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Affiliation(s)
- Roland N Dickerson
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Scott C Berry
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jamie D Ziebarth
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joseph M Swanson
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - George O Maish
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gayle Minard
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rex O Brown
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA
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