Evaluation of Vitamin D3 and Calcium Deficiency after Recovery from Extensive Burn

Effects of vitamin D3 supplementation on the recovery of hospitalized burn patients: a randomized double-blind controlled trial

BACKGROUND

Burn patients, due to their damaged skin, may not be able to synthesize vitamin D. In this study, we aimed to evaluate the effects of vitamin D supplementation on the recovery of hospitalized burn patients.

METHODS

Fifty-four patients participated in a randomized controlled trial. Eighteen patients were randomly assigned to group C (control, received gelatin soft gel as placebo), 18 patients to group D1 (received 1000 IU/day vitamin D), and 18 patients to group D2 (received 3000 IU/day vitamin D). After supplementation, wound biopsy and blood samples were obtained from the patients. Weight, height, 25(OH)D level, wound healing, scar formation, quality of pain, and blood parameters were evaluated.

RESULTS

There were no significant differences in the serum vitamin D levels between the groups at admission (P = 0.52), and 81.5% of the participants were deficient, with a noteworthy increase during study in supplemented groups (P < 0.001). The Bates-Jensen Wound Assessment Tool demonstrated significant differences in wound healing between the C group and the D1 and D2 groups (P = 0.003), and the supplemented groups experienced greater improvement. The D2 group showed significant differences in thickness and total score on the Vancouver scar scale up to three months after discharge (P = 0.03). Moreover, there was a notable decrease in insulin requirements and the number of injected insulin units in the supplemented groups compared with those in group C (P = 0.006 and P = 0.01, respectively). In addition, shorter hospitalization was observed in group D2 (P = 0.04).

CONCLUSION

Supplementation with vitamin D at doses of 1000 and 3000 IU/day improved wound healing and decreased scar thickness as well as exogenous insulin requirements. Overall, at 3000 IU/day, better results were achieved than at 1000 IU/day.

TRIAL REGISTRATION

This article is registered in 24/04/2020 on the Iranian Randomized Clinical Trials Registry (trial registration number (IRCT, code: IRCT20200420047141N1.

Predictive value of serum albumin and calcium levels in burn patients with Pseudomonas aeruginosa infection: A comprehensive analysis of clinical outcomes

In the ongoing challenge to reduce burn-associated mortality rates, this study explores the predictive capacity of clinical factors in burn patients, focusing on vitamin D, calcium, and serum albumin levels during hospitalisation in cases with Pseudomonas aeruginosa infection. Our research involves a comprehensive analysis of 100 burn patients, encompassing crucial clinical parameters such as the burn severity index, serum albumin, vitamin D, and calcium levels at admission. Data were meticulously entered into IBM Statistics SPSS software version 28 and subjected to statistical analysis. The study reveals an average patient age of 39.75 years and a notable 34% mortality rate. Additionally, the average lengths of hospital and intensive care unit (ICU) stays are determined to be 11.33 and 7.79 days, respectively. Significantly, a correlation between calcium and albumin variables and treatment outcomes is established, showcasing their potential to predict variable changes in patient mortality rates. Furthermore, a noteworthy association is observed between serum calcium levels and the duration of ICU hospitalisation. In conclusion, albumin and calcium variables emerge as sensitive and specific indicators for predicting outcomes in burn patients. Importantly, the independence of these factors from the physician's experience and diagnosis reduces human error and thus increases the accuracy of mortality prediction in this patient population.

Effect of vitamin D on clinical outcomes in patients with thermal injury

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.

Is calcium a link between inflammatory bone resorption and heart disease?

Several epidemiologic studies associate bone-resorbing chronic inflammatory conditions with increased risk of atherosclerotic heart disease. These include post-menopausal osteoporosis, spinal cord injury, rheumatoid arthritis, and osteoarthritis. Additional studies have noted that the use of anti-resorptive agents following hip fracture, during rheumatoid arthritis, and prior to intensive care management have resulted in reduced overall mortality and mortality from cardiovascular disorders. The careful study of burn patients has allowed us to detect that children and adolescents have a mechanism that protects them from the entry of calcium into the circulation following inflammatory bone resorption. That is, they respond to pro-inflammatory cytokines by up-regulating the parathyroid calcium-sensing receptor (CaSR) with consequent development of hypocalcemic hypoparathyroidism and hypercalciuria. As extracellular calcium appears to exacerbate and/or prolong the inflammatory response, this responsiveness of the CaSR to inflammatory cytokines may be the factor that reduces cardiovascular morbidity and mortality. In adults with chronic inflammatory conditions, the ability of the CaSR to respond to pro-inflammatory cytokines is lost, suggesting that the calcium that enters the circulation following inflammatory bone resorption may persist in the circulation, entering the small coronary blood vessels and favoring the formation of coronary artery calcification, inflammation, and consequent cardiovascular disease.