The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Effect of vitamin D deficiency in Korean patients with acute respiratory distress syndrome

  • Park, Sojung (Department of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital) ;
  • Lee, Min Gi (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Younsuck (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Huh, Jin Won (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2017.11.15
  • Accepted : 2018.02.01
  • Published : 2018.11.01
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Abstract

Background/Aims: Vitamin D modulates innate and adaptive immune responses, and vitamin D deficiency is associated with increased mortality in hospitalized patients with pneumonia. We evaluated the prevalence of vitamin D deficiency in Korean patients with acute respiratory distress syndrome (ARDS) and its effect on the clinical outcomes of ARDS. Methods: We retrospectively analyzed the data of 108 patients who had a measured serum level of 25-hydroxy vitamin D3 ($25(OH)D_3$) at the time of diagnosis with ARDS. The clinical outcomes were evaluated based on $25(OH)D_3$ levels of 20 ng/mL and stratified by quartiles of $25(OH)D_3$ levels. Results: The mean age of patients was 59.4 years old; 77 (71.3%) were male. Vitamin D deficiency was found in 103 patients (95.4%). The mean $25(OH)D_3$ level was $8.3{\pm}7.0ng/mL$. Neither in-hospital mortality (40.0% vs. 68.0%) nor 6-month mortality (40.0% vs. 71.8%) significantly differed between groups. There were no significant differences in $25(OH)D_3$ level between survivors ($8.1{\pm}7.6ng/mL$) and non-survivors ($8.5{\pm}6.8ng/mL$, p = 0.765). There were no trends toward a difference in mortality among quartiles of $25(OH)D_3$ levels. However, $25(OH)D_3$ levels were inversely related with length of hospital stay and intensive care unit stay among in-hospital survivors. Conclusions: Vitamin D deficiency was prevalent in Korean patients with ARDS. However, levels of vitamin D were not associated with mortality. A large, prospective study is needed to evaluate the effects of vitamin D deficiency on clinical outcomes of ARDS.

Keywords

References

  1. Rubenfeld GD, Caldwell E, Peabody E, et al. Incidence and outcomes of acute lung injury. N Engl J Med 2005;353:1685-1693. https://doi.org/10.1056/NEJMoa050333
  2. Bone RC, Maunder R, Slotman G, et al. An early test of survival in patients with the adult respiratory distress syndrome. The PaO2/FIo2 ratio and its differential response to conventional therapy. Prostaglandin E1 Study Group. Chest 1989;96:849-851. https://doi.org/10.1378/chest.96.4.849
  3. Nin N, Muriel A, Penuelas O, et al. Severe hypercapnia and outcome of mechanically ventilated patients with moderate or severe acute respiratory distress syndrome. Intensive Care Med 2017;43:200-208. https://doi.org/10.1007/s00134-016-4611-1
  4. Stapleton RD, Wang BM, Hudson LD, Rubenfeld GD, Caldwell ES, Steinberg KP. Causes and timing of death in patients with ARDS. Chest 2005;128:525-532. https://doi.org/10.1378/chest.128.2.525
  5. Doyle RL, Szaflarski N, Modin GW, Wiener-Kronish JP, Matthay MA. Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med 1995;152(6 Pt 1):1818-1824. https://doi.org/10.1164/ajrccm.152.6.8520742
  6. Bone RC, Balk R, Slotman G, et al. Adult respiratory distress syndrome. Sequence and importance of development of multiple organ failure. The Prostaglandin E1 Study Group. Chest 1992;101:320-326. https://doi.org/10.1378/chest.101.2.320
  7. Rosenberg AL, Dechert RE, Park PK, Bartlett RH; NIH NHLBI ARDS Network. Review of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort. J Intensive Care Med 2009;24:35-46. https://doi.org/10.1177/0885066608329850
  8. Choi HS, Oh HJ, Choi H, et al. Vitamin D insufficiency in Korea: a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab 2011;96:643-651. https://doi.org/10.1210/jc.2010-2133
  9. Barragan M, Good M, Kolls JK. Regulation of dendritic cell function by vitamin D. Nutrients 2015;7:8127-8151. https://doi.org/10.3390/nu7095383
  10. Berraies A, Hamzaoui K, Hamzaoui A. Link between vitamin D and airway remodeling. J Asthma Allergy 2014;7:23-30.
  11. Mirzakhani H, Al-Garawi A, Weiss ST, Litonjua AA. Vitamin D and the development of allergic disease: how important is it? Clin Exp Allergy 2015;45:114-125. https://doi.org/10.1111/cea.12430
  12. Parker J, Hashmi O, Dutton D, et al. Levels of vitamin D and cardiometabolic disorders: systematic review and meta-analysis. Maturitas 2010;65:225-236. https://doi.org/10.1016/j.maturitas.2009.12.013
  13. Hong Q, Xu J, Xu S, Lian L, Zhang M, Ding C. Associations between serum 25-hydroxyvitamin D and disease activity, inflammatory cytokines and bone loss in patients with rheumatoid arthritis. Rheumatology (Oxford) 2014;53:1994-2001. https://doi.org/10.1093/rheumatology/keu173
  14. Yawn J, Lawrence LA, Carroll WW, Mulligan JK. Vitamin D for the treatment of respiratory diseases: is it the end or just the beginning? J Steroid Biochem Mol Biol 2015;148:326-337. https://doi.org/10.1016/j.jsbmb.2015.01.017
  15. Kerley CP, Elnazir B, Faul J, Cormican L. Vitamin D as an adjunctive therapy in asthma. Part 2: a review of human studies. Pulm Pharmacol Ther 2015;32:75-92. https://doi.org/10.1016/j.pupt.2015.02.010
  16. Ananthakrishnan AN, Cheng SC, Cai T, et al. Association between reduced plasma 25-hydroxy vitamin D and increased risk of cancer in patients with inflammatory bowel diseases. Clin Gastroenterol Hepatol 2014;12:821-827. https://doi.org/10.1016/j.cgh.2013.10.011
  17. Leow L, Simpson T, Cursons R, Karalus N, Hancox RJ. Vitamin D, innate immunity and outcomes in community acquired pneumonia. Respirology 2011;16:611-616. https://doi.org/10.1111/j.1440-1843.2011.01924.x
  18. Holter JC, Ueland T, Norseth J, et al. Vitamin D status and long-term mortality in community-acquired pneumonia: secondary data analysis from a prospective cohort. PLoS One 2016;11:e0158536. https://doi.org/10.1371/journal.pone.0158536
  19. de Haan K, Groeneveld AB, de Geus HR, Egal M, Struijs A. Vitamin D deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis. Crit Care 2014;18:660. https://doi.org/10.1186/s13054-014-0660-4
  20. Moromizato T, Litonjua AA, Braun AB, Gibbons FK, Giovannucci E, Christopher KB. Association of low serum 25-hydroxyvitamin D levels and sepsis in the critically ill. Crit Care Med 2014;42:97-107. https://doi.org/10.1097/CCM.0b013e31829eb7af
  21. Dancer RC, Parekh D, Lax S, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax 2015;70:617-624. https://doi.org/10.1136/thoraxjnl-2014-206680
  22. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012;307:2526-2533.
  23. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2011;96:1911-1930. https://doi.org/10.1210/jc.2011-0385
  24. Darmon M, Clec'h C, Adrie C, et al. Acute respiratory distress syndrome and risk of AKI among critically ill patients. Clin J Am Soc Nephrol 2014;9:1347-1353. https://doi.org/10.2215/CJN.08300813
  25. Caser EB, Zandonade E, Pereira E, Gama AM, Barbas CS. Impact of distinct definitions of acute lung injury on its incidence and outcomes in Brazilian ICUs: prospective evaluation of 7,133 patients*. Crit Care Med 2014;42:574-582. https://doi.org/10.1097/01.ccm.0000435676.68435.56
  26. Seeley E, McAuley DF, Eisner M, Miletin M, Matthay MA, Kallet RH. Predictors of mortality in acute lung injury during the era of lung protective ventilation. Thorax 2008;63:994-998. https://doi.org/10.1136/thx.2007.093658
  27. Villar J, Blanco J, Anon JM, et al. The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med 2011;37:1932-1941. https://doi.org/10.1007/s00134-011-2380-4
  28. Yu S, Christiani DC, Thompson BT, Bajwa EK, Gong MN. Role of diabetes in the development of acute respiratory distress syndrome. Crit Care Med 2013;41:2720-2732. https://doi.org/10.1097/CCM.0b013e318298a2eb
  29. Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC. Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med 2005;33:1191-1198. https://doi.org/10.1097/01.CCM.0000165566.82925.14
  30. Remmelts HH, van de Garde EM, Meijvis SC, et al. Addition of vitamin D status to prognostic scores improves the prediction of outcome in community-acquired pneumonia. Clin Infect Dis 2012;55:1488-1494. https://doi.org/10.1093/cid/cis751
  31. Kim HJ, Jang JG, Hong KS, Park JK, Choi EY. Relationship between serum vitamin D concentrations and clinical outcome of community-acquired pneumonia. Int J Tuberc Lung Dis 2015;19:729-734. https://doi.org/10.5588/ijtld.14.0696
  32. Kankova M, Luini W, Pedrazzoni M, et al. Impairment of cytokine production in mice fed a vitamin D3-deficient diet. Immunology 1991;73:466-471.

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