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Clin Nutr. 2018 Aug;37(4):1238-1246. doi: 10.1016/j.clnu.2017.05.006. Epub 2017 May 11.

Vitamin D supplementation in the critically ill: A systematic review and meta-analysis.

Author information

1
Department of Anesthesiology and Reanimation, Faculty of Médecine and Health Sciences, Sherbrooke University Hospital, Sherbrooke, Québec, Canada.
2
Department of Nutrition, Hospital A. Posadas, Buenos Aires, Argentina.
3
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Medicine, Queen's University, Kingston, ON, Canada.
4
Department of Critical Care, Intensive Care Unit, University Hospital, Faculty of Medicine, UDELAR, Montevideo, Uruguay. Electronic address: wmanzanares@adinet.com.uy.

Abstract

INTRODUCTION:

Vitamin D insufficiency is reported in up to 50% of the critically ill patients and is associated with increased mortality, length of stay (LOS) in intensive care unit (ICU) and hospital, and respiratory disorders with prolonged ventilation. Benefits of vitamin D supplementation remain unclear. The aim of this systematic review was to evaluate the clinical benefits of vitamin D administration in critically ill patients.

METHODS:

We searched Medline, Embase, CINAHL and Cochrane database for randomized controlled trials (RCT) conducted on heterogeneous ICU patients comparing vitamin D administration to placebo. Evaluated outcomes included mortality, infectious complications, hospital/ICU LOS and length of mechanical ventilation. Two independent reviewers assessed eligibility, risk of bias and abstracted data. Data was pooled using a random effect model to estimate the risk ratio (RR) or weighted mean difference. Pre-defined subgroup analysis included oral-enteral vs. parenteral administration, high vs. low dose, vitamin d deficient patient, high vs. low quality trials.

RESULTS:

Six RCTs (695 patients) met study inclusion. No reduction in mortality was found (P = 0.14). No differences in ICU and hospital LOS, infection rate and ventilation days existed. In the subgroup analysis, the oral-enteral group, there was no improvement in mortality (P = 0.12) or hospital LOS (P = 0.16). Daily doses >300,000 IU did not improve mortality (P = 0.12) and ICU LOS (P = 0.12).

CONCLUSIONS:

In critically ill patients, Vitamin D administration does not improve clinical outcomes. The statistical imprecision could be explained by the sparse number of trials.

KEYWORDS:

Calcitriol; Cholecalciferol; Critically ill; Meta-analysis; Vitamin D

PMID:
28549527
DOI:
10.1016/j.clnu.2017.05.006

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