SESSION TYPE: Hot Topics in Respiratory & Critical Care
PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM
PURPOSE: Vitamin D deficiency (<20 ng/dL) and high serum Vitamin B12 (>1000 pg/ml) levels have been reported to be independently associated with poor outcomes in critically ill. Data regarding this association has, however, been sparse. This prospective study evaluated the effect of both these factors, measured at admission,with outcomes in critically ill patients.
METHODS: Consecutive patients with any etiology, admitted to a combined medical and surgical intensive care unit (ICU) at a tertiary care hospital, were included. Patients on prior Vitamin D / Vitamin B12 supplementation, or ICU stay within preceding 1 month, were excluded. Serum 25-hydroxy vitamin D [25(OH)D] and Vitamin B12 levels, baseline parameters, demographic data, APACHE II and SOFA scores were recorded at admission. Primary outcome was hospital survival at 30 days, while secondary outcomes were duration of mechanical ventilation and ICU length of stay.
RESULTS: Of the 1586 patients admitted, 1460 were included in analysis. Of these, 25(OH)D deficiency was observed in 1031 (70.6%) patients. These were younger, male, with kidney disease, lower serum calcium and higher 30-day mortality (all p<0.01). Serum Vitamin B12 was increased in 1186 (81.2%) patients, mainly middle-aged males, with sepsis, multiorgan failure, and higher 30-day mortality (all p < 0.01). Both the factors were present in 896 (61.3%) patients who, on multivariate regression analysis, showed greater APACHE II and SOFA scores [(odds ratio (OR) 1.036; 95% confidence interval (CI) 1.024-1.048, P < 0.0001], greater ventilator requirement (OR 8.2; 95% CI 4.2-13.92, P < 0.0001), longer ICU stay (OR 7.4; 95% CI 4.2-13.98, P < 0.0001) and higher 30-day mortality (OR 7.6; 95% CI 4.2-13.96, P < 0.0001)
CONCLUSIONS: Vitamin D deficiency and high serum Vitamin B12 levels at admission were significant independent predictors of mortality in critically ill patients. Of the two, raised serum Vitamin B12 was more significantly associated with adverse outcomes. Mortality was greater when both the factors were together present.
CLINICAL IMPLICATIONS: Serum Vitamin D and Vitamin B12 levels should be regularly monitored in critically ill patients
DISCLOSURE: The following authors have nothing to disclose: Puneet Khanna, Vikas Maurya, Rajesh Pande
No Product/Research Disclosure InformationBLK Superspeciality Hospital, New Delhi, India