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04.12.2019 | original article | Ausgabe 3-4/2021 Open Access

Wiener klinische Wochenschrift 3-4/2021

Vitamin D assessment in perioperative medicine and critical care

A prospective observational pilot study

Zeitschrift:
Wiener klinische Wochenschrift > Ausgabe 3-4/2021
Autoren:
MD Paul Zajic, MD PhD Stefan Heschl, MD Michael Schörghuber, MD Petra Srekl-Filzmaier, MD Tatjana Stojakovic, MD Viktoria Weixler, MSc Sieglinde Zelzer, MD Karin Amrein
Wichtige Hinweise

Author contributions

PZ and KA designed the study, SH, PSF, MS, VW and PZ performed patient screening, information and inclusion, SZ performed laboratory measurements, PZ and KA performed the statistical analyses, PZ wrote the manuscript, PZ, SH, MS, PSF, TS, VW and KA critically revised the manuscript for important intellectual content. All authors approved of the manuscript ahead of submission.

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Summary

Background

There is controversy about the impact of acute illness on vitamin D levels. This study was carried out to assess the influence of perioperative fluid loading on 25-hydroxy-vitamin D [25(OH)D] levels. The study evaluated the clinical utility of a commonly available chemiluminescence assay (ECLIA, IDS-iSYS) and liquid chromatography/mass spectrometry (LC-MS/MS) in the diagnosis of vitamin D deficiency in this setting.

Methods

In this prospective observational pilot study in adult patients undergoing cardiovascular surgery on cardiopulmonary bypass (CPB), blood samples drawn at preoperative baseline (t1), after weaning from CPB (t2), on intensive care unit (ICU) admission (t3) and on the first (t4) and second (t5) postoperative days were analyzed.

Results

A total of 26 patients (130 samples) were included in this study. Fluid loading by CPB led to a median reduction of 25(OH)D by −22.6% (range −54.5% to −19.5%) between t1 and t2. Cohen’s kappa (κ) for method agreement for vitamin D deficiency (tested cut-off values 20 ng/ml and 12 ng/ml), was κ = 0.291 (p < 0.001) and κ = 0.469 (p < 0.001), respectively. The mean difference between measurements by ECLIA and LC-MS/MS was 4.8 ng/ml (±5.7), Pearson’s r for correlation was 0.73 (p < 0.001). The biologically inactive C3-epimer did not contribute to 25(OH)D levels assessed by LC-MS/MS.

Conclusion

The 25(OH)D measurements by chemiluminescence assays can noticeably deviate from those measured by LC-MS/MS, which can be considered the unequivocal gold standard. These assays may still be acceptably reliable in the screening for vitamin D deficiency, especially in the setting of low vitamin D levels. Stricter definitions, e.g. serum 25(OH)D levels lower than 12 ng/ml, may be used to diagnose deficiency with low false positive rate.

Trial Registration

DRKS00009216, German Clinical Trials Registry (www.​drks.​de)

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