Vitamin D status at ICU admission may predict A-fib and bedsores

By Rob Goodier

NEW YORK (Reuters Health) – Vitamin D status on admission to the surgical intensive care unit may predict patients' risk of new-onset atrial fibrillation and hospital-acquired pressure ulcers, according to preliminary findings presented February 19 at Clinical Nutrition Week 2017 in Orlando, Florida.

“Work that we have presented in the past and the data we presented at CNW17 suggest that assessment for and treatment of low vitamin D status early in critical illness may help to improve immune function, musculoskeletal as well as cardiovascular health, functional outcomes, and even mortality in ICU patients,” Dr. Sadeq Quraishi of Massachusetts General Hospital and Harvard Medical School in Boston, who led the research, told Reuters Health by email.

Dr. Quraishi and colleagues presented data from two prospective observational studies of nutritional status in critically ill surgical patients at Mass General.

In study involving 500 patients, the risk for new-onset atrial fibrillation appeared to rise as 25-hydroxyvitamin D levels declined. Vitamin D deficiency is common in critical illness and that appears to have been the case in the study group as well, the researchers said. The average vitamin D level in the study group was 18 ng/mL, while a healthy level may be 20 ng/mL or higher.

Thirty-six patients developed new-onset atrial fibrillation. Patients with Vitamin D levels below 20 ng/mL were nearly four times as likely to develop new-onset atrial fibrillation, with an odds ratio of 3.59 (95% CI, 1.01–12.70). On regression analysis, the risk for the condition decreased by 15% for each unit increase in vitamin D.

A second study of 402 surgical ICU patients found that 11 percent developed hospital-acquired pressure ulcers. Patients with vitamin D levels below 20 ng/mL were more than twice as likely to develop the ulcers (OR 2.51; 95% CI, 1.06–5.97). On regression analysis, the risk of ulcers fell by 11% with each unit increase in vitamin D.

Commenting by email, Dr. Willem Looijaard of VU University Medical Center in Amsterdam, who was not involved in the research, told Reuters Health, “I'd say the idea of vitamin D status being associated to the development of pressure ulcers and new onset atrial fibrillation in critically ill surgical patients is very interesting as this would provide clinicians with an easy and cheap method of reducing the risk of said complications.”

“However,” Dr. Looijaard added, “further research is warranted to determine a causal effect of vitamin D status with - and the effect of supplementation of vitamin D on - the development of pressure ulcers and new onset atrial fibrillation in this population.”

Further study is ongoing with plans for randomized, controlled trials, Dr. Quraishi said.

SOURCE: http://bit.ly/2lrguRj

Clinical Nutrition Week 2017.

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