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NEWS: Does Vitamin D Status Affect Outcomes in the Neurocritical Care Population?

By Currents Editor posted 09-07-2018 13:52

  
Authors: Guan, J., Karsy, M., Brock, A. et al. “Vitamin D status and 3-month Glasgow Outcome Scale scores in patients in neurocritical care: prospective analysis of 497 patients.” J Neurosurg 128: 1635-1641

Reviewed by: Sara Stern-Nezer, MD, MPH, Assistant Clinical Professor, University of California, Irvine

Read the article.* 
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Background/Study Design

Prior studies have shown that vitamin D deficiency is associated with worse outcomes in general ICU patients, but given data that suggest vitamin D may be neuroprotective, these study authors decided to prospectively study the association between vitamin D status and three month outcomes. Authors collected data on every patient admitted to the neuro-ICU over the age of 18 who was able to undergo vitamin D testing. Patients who did not follow-up at three months were excluded. Demographic information was recorded and admission diagnosis classified as postoperative, stroke, trauma or other. Vitamin D supplementation taken prior to admission was discontinued. Patients who were vitamin-D deficient (<20ng/ml) were started on supplementation. 25-hydroxy vitamin D was assessed within 24 hours of admission, as was GFR. Primary outcome was the Glasgow Outcome Score (GOS) at three months. GOS was dichotomized into poor outcome (1-3) and good outcome (4-5). Univariate analysis was done and variables with p-value of <0.2 were included in a forward, stepwise binomial logistic regression model.

Results

Of 888 unique admissions, 497 patients were included. One-third were excluded secondary to no data at three months and the remainder for non-neurological admission (4.8 percent) readmission to ICU during that hospitalization (3.4 percent), absence of vitamin D level (1.7 percent), and age (0.8 percent). Reason for admission included post-operative (35 percent), trauma (12 percent), stroke (24 percent) and other (29 percent). One hundred eighty-two patients (36.6 percent) were vitamin D deficient and 59 (11.9 percent) met criteria for severe vitamin D deficiency; severely deficient patients were more likely to be younger (p=0.006), smokers (p<0.001), have a higher BMI (p=0.002). There was also a higher rate of pneumonia in this group (13.6 percent vs. 5.0 percent, p=0.010). There was no significant difference in vitamin D status based on reason for admission. Notably, vitamin D deficient patients were significantly more likely to be readmitted or die within 30 days (p=0.014) and less likely to have a good outcome at 30 days (p=0.023). In their final model, the association between three-month outcome and SAPS II score, admission category and vitamin D status remained statistically significant.

Discussion

This paper represents the first paper to analyze admission vitamin D status in the neurocritical care population, which the authors note may be particularly important for CNS recovery. They found that severe vitamin-D deficiency was associated with worse outcomes at three months post-discharge. The study has many strengths, including a large sample size and captures a variety of admission diagnoses common in the neuro-ICU. However, this remains an observational trial. Vitamin D status may be a marker of other factors that lead to worse outcomes, and thus this data does not answer the question of whether vitamin D supplementation in our patient population would improve outcomes. The main finding that argues against vitamin D being a marker for other factors is that younger people were actually more likely to be deficient, and generally younger age is associated with improved outcomes. A future randomized control trial will be necessary to answer whether this modifying vitamin D status can improve outcomes for our patients.
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