On October 1, 2021 the CNS is proud to announce a new and improved user experience for all your SANS education needs. You’ll retain access to any current subscriptions
but answers on exams won’t transfer over - so make sure you complete any exams and claim credit by September 30 or start the new SANS 2021 today

  • The Effect of Supplementation of Vitamin D in Neurocritical Care Patients with Hypovitaminosis D: A Randomized Controlled Clinical Trial

    Final Number:
    183

    Authors:
    Andrea Archambault Brock MD; Michael Karsy MD PhD MSc; Jian Guan MD; Ilyas Eli MD; Sarah Tamara Menacho MD; Min S. Park MD

    Study Design:
    Clinical Research

    Subject Category:
    Trauma and Neurocritical Care: Cranial

    Meeting: Congress of Neurological Surgeons 2019 Annual Meeting

    Introduction: Hypovitaminosis D is prevalent in neurocritical care patients, but the potential to improve patient outcome by replenishing vitamin D has not been investigated. This single-center, double-blinded, placebo-controlled, randomized (1:1) clinical trial was designed to assess the effect on patient outcome of vitamin D supplementation in neurocritical care patients with hypovitaminosis D (NCT02881957).

    Methods: From October 2016 until April 2018, emergently admitted neurocritical care patients with vitamin D deficiency (=20 ng/ml) were randomized to receive vitamin D3 (cholecalciferol, 540,000 IU) (n=134) or placebo (n=133). Hospital length of stay (LOS) was the primary outcome; secondary outcomes included intensive care unit (ICU) LOS, repeat vitamin D levels, patient complications, and patient disposition. Exploratory analysis evaluated specific subgroups of patients by LOS, Glasgow Coma Scale (GCS), and Simplified Acute Physiology Score (SAPS II).

    Results: Two-hundred seventy-four patients were randomized (intent-to-treat) and 267 were administered treatment within 48 hours (as-treated; 61.2% of planned recruitment) and monitored. The mean age of as-treated patients was 54.0±17·2 years (56.9% male, 77.2% White). After interim analysis suggested a low conditional power for outcome difference (predictive power: 0.12), the trial was halted. For as-treated patients, no significant difference in hospital (10.4±14.5 vs. 9.1±7.9 days, p=0.4; mean difference=1.3, 95% CI= -1.5, 4.1) or ICU (ICU: 5.8±7.5 vs. 5.4±6.4 days, p=0.4; mean difference=0.4, 95% CI= -1.3, 2.1) LOS was seen between vitamin D3 and placebo groups. Vitamin D3 supplementation significantly improved repeat serum levels compared with placebo (20.8±9.3 vs. 12.8±4.8 ng/ml, p<.001) without adverse side effects. No subgroups were identified by exclusion of LOS outliers or segregation by GCS score, SAPS II score, or severe vitamin D deficiency (=10 ng/ml).

    Conclusions: Despite studies showing vitamin D can predict prognosis, supplementation in vitamin D–deficient neurocritical care patients did not result in appreciable improvement in outcomes and likely does not play a role in acute clinical recovery.

    Patient Care: This research demonstrated that despite vitamin D playing a biomarker role in prognosis for neurosurgery patients, improvement of outcomes was not achieved with supplementation in an acute setting.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) discuss the role of vitamin D levels in the risk stratification of neurosurgical patients, 2) discuss the role of vitamin D supplementation in improvement of outcomes for neurosurgical patients.

    References: -Guan J, Karsy M, Brock AA, Eli I, Ledyard H, Hawryluk GW, et al: 327 A Prospective Analysis of Hypovitaminosis D and Mortality in 400 Patients in the Neurocritical Care Setting. Neurosurgery 63 Suppl 1:195, 2016 -Guan J, Karsy M, Brock AA, Eli IM, Ledyard HK, Hawryluk GWJ, et al: A prospective analysis of hypovitaminosis D and mortality in 400 patients in the neurocritical care setting. J Neurosurg 127:1–7, 2017 -Guan J, Karsy M, Brock AA, Eli IM, Manton GM, Ledyard HK, 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, 2018 -Guan J, Karsy M, Eli I, Bisson EF, McNally S, Taussky P, et al: Increased Incidence of Hypovitaminosis D Among Patients Requiring Treatment for Cerebral Aneurysms. World Neurosurg 88:15-20, 2016

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy