2016, Number 2
Usefulness of APACHE II, SOFA, CRP and ESR scales as predictors of vitamin D deficiency upon admission to the ICU
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ABSTRACTIntroduction: High prevalence of vitamin D deficiency has been documented in hospital population. In ICU patients, it has been associated with worse outcomes.
Objective: To determine the usefulness of CRP, ESR, APACHE II and SOFA as predictors of vitamin D deficiency upon patient arrival in the ICU. To find the incidence of vitamin D deficiency at the UCI, and its association with mortality and length of stay.
Material and methods: A prospective, analytical, observational, case control study using CRP, ESR, APACHE II and SOFA as predictors of vitamin D deficiency. We recruited 46 patients who were admitted to our ICU in a six-month period. CRP, ESR, APACHE II and SOFA were recorded and 25-hidroxyvitamin D levels were requested at admission and at the seventh day in the ICU. We divided the patients into two groups: those with and without deficiency.
Results: CRP, ESR, APACHE II and SOFA could not predict vitamin D deficiency. We found an increase in the length of stay in deficient patients (p = 0.024). No increased mortality in the vitamin D deficient population. We found 80% of our population with deficiency.
Conclusions: We found a high incidence of vitamin D deficiency and an increased length of stay justifying the measurement of 25-hidroxyvitamin D levels in the critically ill.
Carrillo ER, Zárate VV. Vitamina D en el enfermo grave. Conceptos actuales. Med Int Mex. 2012;28(3):262-268.
Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr. 2008;88(2):491S-499S.
McKinney JD, Bailey BA, Garrett LH, Peiris P, Manning T, Peiris AN. Relationship between vitamin D status and ICU outcomes in veterans. J Am Med Dir Assoc. 2011;12(3):208-211.
Braun AB, Litonjua AA, Moromizato T, Gibbons FK, Giovannucci E, Christopher KB. Association of low serum 25-hydroxyvitamin D levels and acute kidney injury in the critically ill. J Crit Care Med. 2012;40(12):3170-3179.
Braun A, Chang D, Mahadevappa K. Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med. 2011;39(4):671-677.
Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB. Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Crit Care Med. 2012;40(1):63-72.
Joergensen C, Hovind P, Schmedes A, Parving HH, Rossing P. Vitamin D levels, microvascular complications, and mortality in type 1 diabetes. Diabetes Care. 2011;34(5):1081-1085.
DeLuca HF. Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr. 2004;80(6 Suppl):1689S-1696S.
Amrein K, Sourij H, Wagner G, et al. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D deficient patients: a randomized, double-blind, placebo-controlled pilot study. Crit Care. 2011;15(2):R104.
Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab. 2011;25(5):769-781.
Flores M, Sanchez RL y cols. Concentraciones Séricas de vitamina D en niños, adolescentes y adultos mexicanos. Resultados ESNAUT 2006. Salud Pública Mex. 2011;5-29.
Cecchi A, Bonizzoli M, Douar S, et al. Vitamin D deficiency in septic patients at ICU admission is not a mortality predictor. Minerva Anestesiol. 2011;77(12):1139-1140.
Schenk LK. Low 25-hydroxyvitamin D: a significant risk factor for acute kidney injury in critically ill patients. Crit Care Med. 2012;40(12):3314-3315.
Jeng L, Yamshchikov AV, Judd SE, et al. Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 2009;7:28.
Ginde AA, Camargo CA Jr, Shapiro NI. Vitamin D insufficiency and sepsis severity in emergency department patients with suspected infection. Acad Emerg Med. 2011;18(5):551-554.
Miranda CD, Leiva BL, León SJP, De la Maza C. Diagnóstico y tratamiento de la deficiencia de Vitamina D. Rev Chil Nutr. 2009;36(3):269-277.
Mathieu C, Van der Schueren BJ. Vitamin D deficiency is not good for you. Diabetes Care. 2011;34(5):1245-1256.
Lucidarme O, Messai E, Mazzoni T, Arcade M, du Cheyron D. Incidence and risk factors of vitamin D deficiency in critically ill patients: results from a prospective observational study. Intensive Care Med. 2010;36(9):1609-1611.
Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK. Worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality rate in surgical intensive care unit patients. Am J Surg. 2012;204(1):37-43.
Krishnan A, Ochola J, Mundy J, et al. Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. Crit Care. 2010;14(6):R216.
Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr. 2008;88(2):537S-540S.
Ferreira FL, Boda DP, Bross A, Mélot C. Serial evaluation of the sofa score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754-1758.
Cecchi A, Zagli G, Peris A. Vitamin D deficiency in septic patients at ICU admission is not a mortality predictor. Minerva Anestesiol. 2012;78(4):511-512.
Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin d deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr. 2012;36(6):713-720.
Flynn L, Zimmerman LH, McNorton K, et al. Effects of vitamin D deficiency in critically ill surgical patients. Am J Surg. 2012;203(3):379-382.
Unger MD, Cuppari L, Titan SM, et al. Vitamin D status in a sunny country: where has the sun gone? Clin Nutr. 2010;29(6):784-788.
Mascitelli L, Grant WB, Goldstein MR. Statins, vitamin D, and severe sepsis. Eur J Intern Med. 2011;22(4):e25-26.