According to a recent study (NEJM 2019; 381: 2529-40), correction of vitamin D deficiency in critically-ill has NO significant effects on mortality and other non-fatal outcomes.
The article notes that observational data have indicated that Vitamin D deficiency is common in critically ill patients and has been associated with longer lengths of stay, prolonged ventilation and death. However, “vitamin D level is considered a marker of coexisting conditions and frailty, and residual confounding may drive theses associations.”
Methods: a randomized, double-blind, placebo-controlled, phase 3 trial of early vitamin D3 supplementation in critically ill, vitamin D–deficient patients who were at high risk for death. Randomization occurred within 12 hours after the decision to admit the patient to an intensive care unit. Eligible patients received a single enteral dose of 540,000 IU of vitamin D3 or matched placebo.
- A total of 1360 patients were found to be vitamin D–deficient during point-of-care screening and underwent randomization. Of these patients, 1078 had baseline vitamin D deficiency (25-hydroxyvitamin D level, <20 ng per milliliter [50 nmol per liter]) confirmed by subsequent testing and were included in the primary analysis population.
- The mean day 3 level of 25-hydroxyvitamin D was 46.9±23.2 ng per milliliter (117±58 nmol per liter) in the vitamin D group and 11.4±5.6 ng per milliliter (28±14 nmol per liter) in the placebo group
- The 90-day mortality was 23.5% in the vitamin D group (125 of 531 patients) and 20.6% in the placebo group (109 of 528 patients) (difference, 2.9 percentage points; 95% CI, −2.1 to 7.9; P=0.26). There were no clinically important differences between the groups with respect to secondary clinical, physiological, or safety end points.
My take: Correction of low serum vitamin D levels did not improve outcomes. This likely indicates that low vitamin D levels are often an epiphenomenon of critical illness and not a contributing causal etiology.
Related blog posts:
- Why I Don’t Check Vitamin D Levels During IBD Flareups
- What happens to micronutrient levels in the hospital setting? When CRP concentration is >20 mg/L (>2 mg/dL), “plasma concentrations of selenium, zinc, and vitamins A, B-6, C, and D are clinically uninterpretable.
- Common to be “D-ficient” | gutsandgrowth
- Explaining the Vitamin D Paradox | gutsandgrowth
- Why Adding Vitamin D May Not Help IBD | gutsandgrowth
- The Search for a Dietary Culprit in IBD | gutsandgrowth
- Vitamin D, IBD, and Causality | gutsandgrowth
- Single High-Dose Oral Vitamin D Therapy … – gutsandgrowth
- Understanding Why Vitamin D Deficiency is Not So Common Afterall | gutsandgrowth