nach oben

Journal für Endokrinologie, Diabetologie und Stoffwechsel

Erschienen in:

01.12.2017 | Originalien

Vitamin D bei kritisch kranken Erwachsenen

verfasst von: Elisabeth Altendorfer, Steven Amrein, Karin Amrein

Erschienen in: Journal für Endokrinologie, Diabetologie und Stoffwechsel | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Zusammenfassung

Einleitung und Ziele

Studien der letzten Jahrzehnte brachten neue Erkenntnisse über die Rolle von Vitamin D in einer Vielzahl von Erkrankungen. Momentan wird der Vitamin-D-Mangel als modifizierbarer Risikofaktor für Morbidität und Mortalität bei Intensivpatienten diskutiert. Ziel dieser Arbeit ist es, einen Überblick über die zu dem Thema bisher veröffentlichten Studien und deren Ergebnisse zu geben.

Methoden

Für diese Arbeit wurde die Methode einer Literaturstudie gewählt. Nach relevanter medizinischer Fachliteratur wurde über PubMed gesucht.

Ergebnisse

Es wurden 30 Beobachtungsstudien im ICU-Setting (Intensive Care Unit), vier ICU-Beobachtungsstudien bei Kindern und neun relevante Beobachtungsstudien außerhalb des ICU-Settings gefunden. Seit 2003 wurden in Österreich, Belgien, Australien und den USA neun randomisiert kontrollierte Studien zu Vitamin-D-Supplementation bei kritisch kranken Erwachsenen mit Teilnehmerzahlen zwischen 25 und 475 durchgeführt (gesamt n = 716). In den Interventionsstudien zeigte sich ein relatives Mortalitätsrisiko von 0,69 bis 1,17 (gesamt 0,70).

Schlussfolgerungen

Ein Vitamin-D-Mangel bei kritisch Kranken ist weltweit häufig und mit schlechtem Outcome assoziiert. Bisher gibt es vielversprechende, jedoch heterogene und daher unzulängliche Daten zum potenziellen Benefit einer hochdosierten, kostengünstigen Vitamin-D-Substitution in diesem vulnerablen Kollektiv. Um die vermuteten positiven Effekte einer Vitamin-D-Substitution zu bestätigen, bedarf es dringend großer Phase-III-Interventionsstudien bei kritisch kranken Erwachsenen und Kindern.

Vorheriger Artikel Primärer Hyperaldosteronismus: Diagnostik und Therapie

Nächster Artikel Perioperatives Management von Menschen mit Diabetes bei elektiven Eingriffen

Rippel C, South M, Butt WW, Shekerdemian LS (2012) Vitamin D status in critically ill children. Intensive Care Med 38(12):2055–2062CrossRefPubMed

Jeng L, Yamshchikov AV, Judd SE, Blumberg HM, Martin GS, Ziegler TR et al (2009) Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med 7(1):28CrossRefPubMedPubMedCentral

Zajic P, Amrein K (2014) Vitamin D deficiency in the ICU: a systematic review. Minerva Endocrinol 39(4):275–287PubMed

Lee P (2011) Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 25(5):769–781CrossRefPubMed

Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 87(4):1080 s–1086 sPubMed

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930CrossRefPubMed

Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281CrossRefPubMed

Amrein K, Venkatesh B (2012) Vitamin D and the critically ill patient. Curr Opin Clin Nutr Metab Care 15(2):188–193CrossRefPubMed

Nagpal S, Na S, Rathnachalam R (2005) Noncalcemic actions of vitamin D receptor ligands. Endocr Rev 26(5):662–687CrossRefPubMed

10.

Bouillon R, Carmeliet G, Verlinden L, van Etten E, Verstuyf A, Luderer HF et al (2008) Vitamin D and human health: lessons from vitamin D receptor null mice. Endocr Rev 29(6):726–776CrossRefPubMedPubMedCentral

11.

DeLuca HF (2004) Overview of general physiologic features and functions of vitamin D. Am J Clin Nutr 80(6 Suppl):1689 s–1696 sPubMed

12.

Hullett DA, Cantorna MT, Redaelli C, Humpal-Winter J, Hayes CE, Sollinger HW et al (1998) Prolongation of allograft survival by 1,25-dihydroxyvitamin D3. Transplantation 66(7):824–828CrossRefPubMed

13.

Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P et al (2017) Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 356:i6583CrossRefPubMedPubMedCentral

14.

Brown J, Amling M, Barvencik F (2011) Möglichkeiten zur Verbesserung des Vitamin-D-Status der Bevölkerung. J Mineralstoffwechs Muskuloskelet Erkrank 18(3):104–109

15.

McNally JD, Menon K, Chakraborty P, Fisher L, Williams KA, Al-Dirbashi OY et al (2013) Impact of anesthesia and surgery for congenital heart disease on the vitamin d status of infants and children: a prospective longitudinal study. Anesthesiology 119(1):71–80CrossRefPubMed

16.

Amrein K, Christopher KB, McNally JD (2015) Understanding vitamin D deficiency in intensive care patients. Intensive Care Med 41(11):1961–1964CrossRefPubMed

17.

Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96(1):53–58CrossRefPubMed

18.

Amrein K, Schnedl C, Holl A, Riedl R, Christopher KB, Pachler C et al (2014) Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA 312(15):1520–1530CrossRefPubMed

19.

Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK (2012) Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr 36(6):713–720CrossRefPubMed

20.

Bacon CJ, Gamble GD, Horne AM, Scott MA, Reid IR (2009) High-dose oral vitamin D3 supplementation in the elderly. Osteoporos Int 20(8):1407–1415CrossRefPubMed

21.

von Restorff C, Bischoff-Ferrari HA, Theiler R (2009) High-dose oral vitamin D3 supplementation in rheumatology patients with severe vitamin D3 deficiency. Bone 45(4):747–749CrossRef

22.

Braun A, Chang D, Mahadevappa K, Gibbons FK, Liu Y, Giovannucci E et al (2011) Association of low serum 25-hydroxyvitamin D levels and mortality in the critically ill. Crit Care Med 39:671–677CrossRefPubMedPubMedCentral

23.

Cecchi A, Bonizzoli M, Douar S, Mangini M, Paladini S, Gazzini B et al (2011) Vitamin D deficiency in septic patients at ICU admission is not a mortality predictor. Minerva Anestesiol 77(12):1184–1189PubMed

24.

McKinney JD, Bailey BA, Garrett LH, Peiris P, Manning T, Peiris AN (2011) Relationship between vitamin D status and ICU outcomes in veterans. J Am Med Dir Assoc 12(3):208–211CrossRefPubMed

25.

Venkatram S, Chilimuri S, Adrish M, Salako A, Patel M, Diaz-Fuentes G (2011) Vitamin D deficiency is associated with mortality in the medical intensive care unit. Critical Care 15(6):R292CrossRefPubMedPubMedCentral

26.

Arnson Y, Gringauz I, Itzhaky D, Amital H (2012) Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients. QJM 105(7):633–639CrossRefPubMed

27.

Braun AB, Gibbons FK, Litonjua AA, Giovannucci E, Christopher KB (2012) Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Crit Care Med 40:63–72CrossRefPubMedPubMedCentral

28.

Matthews LR, Ahmed Y, Wilson KL, Griggs DD, Danner OK (2012) 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 204(1):37–43CrossRefPubMedPubMedCentral

29.

Flynn L, Zimmerman LH, McNorton K, Dolman M, Tyburski J, Baylor A et al (2012) Effects of vitamin D deficiency in critically ill surgical patients. Am J Surg 203(3):379–382CrossRefPubMed

30.

Su LX, Jiang ZX, Cao LC, Xiao K, Song JP, Li H et al (2013) Significance of low serum vitamin D for infection risk, disease severity and mortality in critically ill patients. Chin Med J 126(14):2725–2730PubMed

31.

Aygencel G, Turkoglu M, Tuncel AF, Candir BA, Bildaci YD, Pasaoglu H (2013) Is vitamin d insufficiency associated with mortality of critically ill patients? Crit Care Res Pract 2013:856747PubMedPubMedCentral

32.

Hu J, Luo Z, Zhao X, Chen Q, Chen Z, Qin H et al (2013) Changes in the calcium-parathyroid hormone-vitamin d axis and prognosis for critically ill patients: a prospective observational study. PLOS ONE 8(9):e75441CrossRefPubMedPubMedCentral

33.

Nair P, Lee P, Reynolds C, Nguyen ND, Myburgh J, Eisman JA et al (2013) Significant perturbation of vitamin D-parathyroid-calcium axis and adverse clinical outcomes in critically ill patients. Intensive Care Med 39:267–274CrossRefPubMed

34.

Moromizato T, Litonjua AA, Braun AB, Gibbons FK, Giovannucci E, Christopher KB (2014) Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill. Crit Care Med 42(1):97–107CrossRefPubMed

35.

Padhi R, Panda B, Jagati S, Patra SC (2014) Vitamin D status in adult critically ill patients in eastern India: an observational retrospective study. Lung India 31(3):212–216CrossRefPubMedPubMedCentral

36.

Quraishi SA, Bittner EA, Blum L, McCarthy CM, Bhan I, Camargo CA Jr. (2014) Prospective study of vitamin D status at initiation of care in critically ill surgical patients and risk of 90-day mortality. Crit Care Med 42(6):1365–1371CrossRefPubMedPubMedCentral

37.

Barnett N, Zhao Z, Koyama T, Janz DR, Wang CY, May AK, Bernard GR, Ware LB (2014) Vitamin D deficiency and risk of acute lung injury in severe sepsis and severe trauma: a case-control study. Annals of Intensive Care 4(1):5CrossRefPubMedPubMedCentral

38.

Ala-Kokko TI, Mutt SJ, Nisula S, Koskenkari J, Liisanantti J, Ohtonen P et al (2016) Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: Observational FINNAKI cohort study. Ann Med 48(1–2):67–75CrossRefPubMed

39.

Alizadeh N, Khalili H, Mohammadi M, Abdollahi A (2015) Serum Vitamin D levels at admission predict the length of intensive care unit stay but not in-hospital mortality of critically ill surgical patients. J Res Pharm Pract 4(4):193–198CrossRefPubMedPubMedCentral

40.

Leaf DE, Croy HE, Abrahams SJ, Raed A, Waikar SS (2015) Cathelicidin antimicrobial protein, vitamin D, and risk of death in critically ill patients. Crit Care 19:80CrossRefPubMedPubMedCentral

41.

Moraes RB, Friedman G, Wawrzeniak IC, Marques LS, Nagel FM, Lisboa TC, Czepielewski MA (2015) Vitamin D deficiency is independently associated with mortality among critically ill patients. Clinics 70(5):326–332CrossRefPubMedPubMedCentral

42.

Brook K, Camargo CA, Christopher KB, Quraishi SA (2015) Admission vitamin D status is associated with discharge destination in critically ill surgical patients. Annals of Intensive Care 5(1)

43.

Kempker JA, West KG, Kempker RR, Siwamogsatham O, Alvarez JA, Tangpricha V et al (2015) Vitamin D status and the risk for hospital-acquired infections in critically ill adults: a prospective cohort study. PLOS ONE 10(4):e122136CrossRefPubMedPubMedCentral

44.

De Pascale G, Vallecoccia MS, Schiattarella A, Di Gravio V, Cutuli SL, Bello G, Montini L, Pennisi MA, Spanu T, Zuppi C, Quraishi SA, Antonelli M (2016) Clinical and microbiological outcome in septic patients with extremely low 25-hydroxyvitamin D levels at initiation of critical care. Clinical Microbiology and Infection 22(5):456.e7-456.e13CrossRef

45.

Guan J, Karsy M, Brock AA, Eli I, Ledyard H, Hawryluk GW et al (2016) A prospective analysis of hypovitaminosis D and mortality in 400 patients in the neurocritical care setting. Neurosurgery 63(Suppl 1):195CrossRefPubMed

46.

Vosoughi N, Kashefi P, Abbasi B, Feizi A, Askari G, Azadbakht L (2016) The relationship between Vitamin D, clinical outcomes and mortality rate in ICU patients: a prospective observational study. J Res Med Sci 21:75CrossRefPubMedPubMedCentral

47.

Anwar E, Hamdy G, Taher E, Fawzy E, Abdulattif S, Attia MH (2017) Burden and Outcome of Vitamin D Deficiency Among Critically Ill Patients: A Prospective Study. Nutr Clin Pract 32(3):378–384CrossRefPubMed

48.

Madden K, Feldman HA, Smith EM, Gordon CM, Keisling SM, Sullivan RM, Hollis BW, Agan AA, Randolph AG (2012) Vitamin D Deficiency in Critically Ill Children. PEDIATRICS 130(3):421–428CrossRefPubMedPubMedCentral

49.

McNally JD, Menon K, Chakraborty P, Fisher L, Williams KA, Al-Dirbashi OY, Doherty DR (2012) The Association of Vitamin D Status With Pediatric Critical Illness. PEDIATRICS 130(3):429–436CrossRefPubMed

50.

Ebenezer K, Job V, Antonisamy B, Dawodu A, Manivachagan MN, Steinhoff M (2016) Serum Vitamin D Status and Outcome among Critically Ill Children Admitted to the Pediatric Intensive Care Unit in South India. The Indian Journal of Pediatrics 83(2):120–125CrossRefPubMed

51.

Sankar J, Lotha W, Ismail J, Anubhuti C, Meena RS, Sankar MJ (2016) Vitamin D deficiency and length of pediatric intensive care unit stay: a prospective observational study. Annals of Intensive Care 6(1)

52.

Ginde AA, Camargo CA, Shapiro NI (2011) Vitamin D Insufficiency and Sepsis Severity in Emergency Department Patients With Suspected Infection. Academic Emergency Medicine 18(5):551–554CrossRefPubMed

53.

Remmelts HHF, van de Garde EMW, Meijvis SCA, Peelen ELGCA, Damoiseaux JGMC, Grutters JC, Biesma DH, Bos WJW, Rijkers GT (2012) Addition of Vitamin D Status to Prognostic Scores Improves the Prediction of Outcome in Community-Acquired Pneumonia. Clinical Infectious Diseases 55(11):1488–1494CrossRefPubMed

54.

Borgermann J, Lazouski K, Kuhn J, Dreier J, Schmidt M, Gilis-Januszewski T et al (2012) 1,25-Dihydroxyvitamin D fluctuations in cardiac surgery are related to age and clinical outcome. Crit Care Med 40:2073–2081CrossRefPubMed

55.

Quraishi SA, Litonjua AA, Moromizato T, Gibbons FK, Camargo CA, Giovannucci E, Christopher KB (2013) Association between prehospital vitamin D status and hospital-acquired bloodstream infections. American Journal of Clinical Nutrition 98(4):952–959CrossRefPubMedPubMedCentral

56.

Lange N, Litonjua AA, Gibbons FK, Giovannucci E, Christopher KB (2013) Pre-hospital Vitamin D Concentration, Mortality, and Bloodstream Infection in a Hospitalized Patient Population. The American Journal of Medicine 126(7):640.e19-640.e27CrossRef

57.

Nguyen HB, Eshete B, Lau KHW, Sai A, Villarin M, Baylink D, Caldwell CC (2013) Serum 1,25-Dihydroxyvitamin D: An Outcome Prognosticator in Human Sepsis. PLoS ONE 8(5):e64348CrossRefPubMedPubMedCentral

58.

Sriram K, Perumal K, Alemzadeh G, Osei A, Voronov G (2015) The relationship between immediate preoperative serum 25-hydroxy-vitamin D3 levels and cardiac function, dysglycemia, length of stay, and 30-d readmissions in cardiac surgery patients. Nutrition 31(6):820–826CrossRefPubMed

59.

Zittermann A, Kuhn J, Ernst JB, Becker T, Larisch J, Dreier J, Knabbe C, Börgermann J, Gummert JF, Slominski AT (2016) Circulating 25-Hydroxyvitamin D and 1,25-Dihydroxyvitamin D Concentrations and Postoperative Infections in Cardiac Surgical Patients: The CALCITOP-Study. PLOS ONE 11(6):e0158532CrossRefPubMedPubMedCentral

60.

Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R (2003) Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab 88(10):4623–4632CrossRefPubMed

61.

Amrein K, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH et al (2011) 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 15(2):R104CrossRefPubMedPubMedCentral

62.

Grossmann RE, Zughaier SM, Kumari M, Seydafkan S, Lyles RH, Liu S et al (2012) Pilot study of vitamin D supplementation in adults with cystic fibrosis pulmonary exacerbation: a randomized, controlled trial. Dermatoendocrinol 4(2):191–197CrossRefPubMedPubMedCentral

63.

Leaf DE, Raed A, Donnino MW, Ginde AA, Waikar SS (2014) Randomized controlled trial of calcitriol in severe sepsis. Am J Respir Crit Care Med 190(5):533–541CrossRefPubMedPubMedCentral

64.

Nair P, Venkatesh B, Lee P, Kerr S, Hoechter DJ, Dimeski G et al (2015) A randomized study of a single dose of intramuscular cholecalciferol in critically ill adults. Crit Care Med 43(11):2313–2320CrossRefPubMed

65.

Quraishi SA, De Pascale G, Needleman JS, Nakazawa H, Kaneki M, Bajwa EK et al (2015) Effect of cholecalciferol supplementation on vitamin D status and cathelicidin levels in sepsis: a randomized, placebo-controlled trial. Crit Care Med 43(9):1928–1937CrossRefPubMedPubMedCentral

66.

Han JE, Jones JL, Tangpricha V, Brown MA, Brown LA, Hao L et al (2016) High dose vitamin D administration in ventilated intensive care unit patients: a pilot double blind randomized controlled trial. J Clin Transl Endocrinol 4:59–65CrossRefPubMedPubMedCentral

67.

Han JE, Alvarez JA, Jones JL, Tangpricha V, Brown MA, Hao L et al (2017) Impact of high-dose vitamin D3 on plasma free 25-hydroxyvitamin D concentrations and antimicrobial peptides in critically ill mechanically ventilated adults. Nutrition 38:102–108CrossRefPubMed

68.

Weng H, Li JG, Mao Z, Zeng XT (2016) Randomised trials of vitamin D3 for critically ill patients in adults: systematic review and meta-analysis with trial sequential analysis. Intensive Care Med 43(2):277–278CrossRefPubMed

69.

McNally JD, Ginde AA, Amrein K (2017) Clarification needed for the systematic review of vitamin D trials in the ICU. Intensive Care Med 43(4):595–596CrossRefPubMed

70.

Putzu A, Belletti A, Cassina T, Clivio S, Monti G, Zangrillo A et al (2017) Vitamin D and outcomes in adult critically ill patients. A systematic review and meta-analysis of randomized trials. J Crit Care 38:109–114CrossRefPubMed

71.

Alizadeh N, Khalili H, Mohammadi M, Abdollahi A (2015) Serum Vitamin D levels at admission predict the length of intensive care unit stay but not in-hospital mortality of critically ill surgical patients. Journal of Research in Pharmacy Practice 4(4):193CrossRefPubMedPubMedCentral

72.

Langlois PL, Szwec C, D’Aragon F, Heyland DK, Manzanares W (2017) Vitamin D supplementation in the critically ill: a systematic review and meta-analysis. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.05.006

73.

Amrein K, Zajic P, Schnedl C, Waltensdorfer A, Fruhwald S, Holl A et al (2014) Vitamin D status and its association with season, hospital and sepsis mortality in critical illness. Crit Care 18(2):R47CrossRefPubMedPubMedCentral

74.

Amrein K, Quraishi SA, Litonjua AA, Gibbons FK, Pieber TR, Camargo CA Jr. et al (2014) Evidence for a U-shaped relationship between prehospital vitamin D status and mortality: a cohort study. J Clin Endocrinol Metab 99(4):1461–1469CrossRefPubMedPubMedCentral

Titel: Vitamin D bei kritisch kranken Erwachsenen
verfasst von: Elisabeth Altendorfer
Steven Amrein
Karin Amrein
Publikationsdatum: 01.12.2017
Verlag: Springer Vienna
Erschienen in: Journal für Endokrinologie, Diabetologie und Stoffwechsel / Ausgabe 4/2017
Print ISSN: 3004-8915
Elektronische ISSN: 3004-8923
DOI: https://doi.org/10.1007/s41969-017-0009-0

Springer Medizin Österreich

Zusammenfassung

Einleitung und Ziele

Methoden

Ergebnisse

Schlussfolgerungen

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2017

Gastroenteropankreatische Neuroendokrine Neoplasien (GEP-NENs) – Update und neue WHO-Klassifikation 2017 der pankreatischen neuroendokrinen Neoplasien

Perioperatives Management von Menschen mit Diabetes bei elektiven Eingriffen

Vorsorgliche Entnahme und Tiefkühlkonservierung von Keimzellen, Hoden- oder Eierstockgewebe Minderjähriger?

Primärer Hyperaldosteronismus: Diagnostik und Therapie

Kardiovaskuläre Outcome-Studien in der Diabetologie – ein Überblick

Erfahrungen mit Lenvima® im klinischen Alltag an der Nuklearmedizin Klagenfurt