Introduction: Hypovitaminosis D is highly prevalent among the general population. Studies have shown an association between hypovitaminosis D and multiple negative outcomes in critical care patients, but there has been no prospective evaluation of hypovitaminosis D in the neurological critical care population. The authors examined the impact of vitamin D deficiency on in-hospital mortality and a variety of secondary outcomes in the neurocritical care unit.
Methods: The authors prospectively collected 25-hydroxy vitamin D levels on all patients admitted to the neurocritical care unit of a quaternary-care center over a three-month period. Demographic data, illness acuity, in-hospital mortality, infection, and length of hospitalization were collected. Univariate and multivariable logistic regression were used to examine the effects of vitamin D deficiency.
Results: Four hundred sixty-one patients met the inclusion criteria. In-hospital mortality was slightly worse (9.3% vs. 4.5%, p=0.059) among patients with deficient vitamin D (<=20 ng/dL). There was also a higher rate of urinary tract infection in patients with vitamin D deficiency (12.4% vs. 4.2%, p=0.002). For patients admitted to the neurocritical care unit emergently (N=285), higher SAPS II score (OR 13.33, 95% CI 1.69–100, p=0.014) and vitamin D deficiency (OR 3.03, 95% CI 1.14–8.06, p=0.027) were significantly associated with increased in-hospital mortality on multivariable analysis.
Conclusions: In the subset of patients admitted to the neurocritical care unit emergently, vitamin D deficiency is significantly associated with higher in-hospital mortality. Larger studies are needed to confirm these findings and to investigate the role of vitamin D supplementation in these patients.
Patient Care: Hypovitaminosis D is highly prevalent among patients admitted to critical care units. Our study is the first to highlight this issue in the neurocritical care population, and awareness of the association of hypovitaminosis D with negative outcomes may allow for further inquiry into possible amelioration of this common vitamin deficiency.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the prevalence of hypovitaminosis D in the neurocritical care population.
2) Discuss, in small groups, the association of hypovitaminosis D and mortality in the neurocritical care unit.
3) Identify morbidity associated with hypovitaminosis D in the neurocritical care population.