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Reduced vitamin D levels associated with infection in ICU patients

Reduced vitamin D levels associated with infection in ICU patients

Friday, July 19, 2013. A study conducted by Korean researchers, published in the June 2013 issue of Neural Regeneration Research, revealed a greater risk of deficient serum levels of vitamin D in patients who had undergone treatment at a neurosurgical intensive care unit (ICU).

Je Hoon Jeong, MD, PhD, of Soon Chun Hyang University Bucheon Hospital and colleagues evaluated serum 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in 55 men and women who were hospitalized at a neurosurgical ICU. The results of blood testing for white blood cell count and neutrophil percentage indicated suspected infection in 15 patients, which was confirmed by sputum, urine or blood bacterial culture in ten patients.

Two weeks after ICU admission, average serum 25-hydroxyvitamin D levels decreased to deficient levels defined as less than 10 nanograms per milliliter (ng/mL) and serum 1,25-dihydroxyvitamin D levels became deficient after four weeks. The researchers observed a trend toward increased white blood cell counts and neutrophil percentages in association with declining levels of vitamin D. In comparison with subjects who did not have signs of infection, serum 25-hydroxyvitamin D levels were significantly lower in both those with suspected and confirmed infection at all time points up to 28 days following admission.

The authors note that research has demonstrated a role for vitamin D in regulating normal innate and adaptive immunity, and that the active form of the vitamin has been shown to stimulate the innate immune system by elevating the production of interleukin-1 and increasing the proliferation of monocytes (a type of white blood cell). "Vitamin D supplementation has been demonstrated to yield good effects for infectious diseases including pneumonia," they write. "The optimal dosage of vitamin D required to both normalize the deficiency observed in the intensive care unit setting and potentially have a favorable effect on infection and other outcomes is currently unknown and requires further study."

"Future studies should clarify whether vitamin D supplementation can improve survival in patients admitted to the neurosurgical intensive care unit," they conclude.

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Meta-analysis indicates preventive effect for vitamin D against risk of respiratory tract infection

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The June 2013 issue of the journal PLOSONE (Public Library of Science One) published the results of a meta-analysis conducted by researchers at Sweden's Karolinska Institutet which found a protective role for supplementing with D to reduce the risk of respiratory tract infection.

For their analysis, Jonatan D. Lindh of the Karolinska Institutet's Division of Clinical Pharmacy and his associates selected 11 randomized, placebo-controlled trials that included a total of 5,660 participants averaging 16 years of age. The average dose of vitamin D was 1,600 international units (IU) administered orally. Follow-up periods ranged for three months to three years.

Supplementation with vitamin D resulted in a 36% lower risk of respiratory tract infection compared to placebo in a summary of all 11 trials. When studies using daily dosing regimens were examined, vitamin D supplementation resulted in a 49% lower risk of infection in comparison with the placebo, while large bolus doses administered monthly or less frequently were not as effective. The researchers attribute this phenomenon to an immunosuppressive effect associated with very high doses of vitamin D, which renders high bolus doses of the vitamin useful for the treatment of inflammatory disorders, including multiple sclerosis. "This could explain why many of the studies using bolus doses have provided null effect and is also important information when designing future interventional studies," the authors remark.

"Aggregated evidence from 11 randomized controlled trials indicates that supplementation with vitamin D could be an effective means of preventing respiratory tract infection," they conclude. "However, due to heterogeneity of included studies and possible publication bias in the field, these results should be interpreted with caution. Thus, additional studies addressing the impact of dosing regimen and choice of target population are warranted before definite conclusions can be drawn."

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