Department of Anesthesia and Intensive Care Medicine, Operational Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
Department of Anesthesiology and Critical Care, Yale New Haven Hospital, New Haven, Connecticut, USA.
Acta Anaesthesiol Scand. 2022 Nov;66(10):1202-1210. doi: 10.1111/aas.14137. Epub 2022 Aug 29.
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.
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 (D ), 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.
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.
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.
尽管多项研究表明，25（OH）D 维生素水平低与危重症患者的预后较差有关，但在没有基线或目标血液水平指导的情况下，通过固定剂量肠内补充来改善预后的尝试均未成功。由于单次 25（OH）D 测量可能无法最佳反映个体的维生素 D 状态，因此我们研究了不同维生素 D 代谢物的血浆浓度及其在急性危重症期间和之后的恢复情况。
这是一项前瞻性观察性研究，纳入了在冰岛雷克雅未克的一家混合内科-外科 ICU 住院的 18 岁及以上的患者，该医院位于高北纬地区（64°N）。在三个时间点测量了维生素 D 代谢物；入院时（S1）、入院后 3-5 天（S2）和急性疾病康复后（中位数 178 天）（S3）。采用液相色谱-串联质谱法（LC-MS/MS）测量总 25（OH）D 维生素、胆钙化醇（D）、总 24、25（OH）D 维生素和维生素 D 结合蛋白（VDBP）的浓度，并用酶联免疫吸附测定法测量游离 25-（OH）D 浓度。
大多数个体在危重症期间被评估为维生素 D 缺乏，37/40 名个体在 S1 时 25（OH）D 维生素水平低于 30ng/ml，34/38 名个体在 S2 时水平低于 30ng/ml。在康复后，30 名患者中有 18 名在 S3 时仍缺乏维生素 D。在危重症期间，所有测量的维生素 D 代谢物水平均较低，但在急性疾病缓解后显著升高。在急性疾病和康复之间的间隔内，没有发现急性疾病严重程度或持续时间的标志物与维生素 D 代谢物的恢复之间存在很强的相关性。
在危重症患者中，多种维生素 D 代谢物水平较低，但在急性疾病缓解后会大量恢复。目前尚不清楚单个代谢物是否足以评估危重症患者的维生素 D 状态并指导潜在的补充。
