Association of Low Serum 25-Hydroxyvitamin D Levels and Sepsis in the Critically Ill (original) (raw)
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Endocrine Practice, 2012
Given the importance of inflammation in acute kidney injury and the relationship between vitamin D and inflammation, we sought to elucidate the effect of vitamin D on acute kidney injury. We hypothesized that deficiency in 25-hydroxyvitamin D prior to hospital admission would be associated with acute kidney injury in the critically ill. Design: Two-center observational study of patients treated in medical and surgical intensive care units. Setting: Two hundred nine medical and surgical intensive care beds in two teaching hospitals in Boston, Massachusetts. Patients: Two thousand seventy-five patients, aged ≥18 yrs, in whom serum 25-hydroxyvitamin D was measured prior to hospitalization between 1998 and 2009. Interventions: None. Measurements and Main Results: The exposure of interest was preadmission serum 25-hydroxyvitamin D and categorized a priori as deficiency (25-hydroxyvitamin D ≤15 ng/mL), insufficiency (25-hydroxyvitamin D 15-30 ng/mL), or sufficiency (25-hydroxyvitamin D ≥30 ng/mL). The primary outcome was acute kidney injury defined as meeting Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) Injury or Failure criteria. Logistic regression examined the RIFLE criteria outcome. Adjusted odds ratios were estimated by multivariate logistic regression models. Preadmission 25-hydroxyvitamin D deficiency is predictive of acute kidney injury. Patients with 25-hydroxyvitamin D deficiency have an odds ratio for acute kidney injury of 1.73 (95% confidence interval 1.30-2.30; p < .0001) relative to patients with 25-hydroxyvitamin D sufficiency. 25-Hydroxyvitamin D deficiency remains a significant predictor of acute kidney injury following multivariable adjustment (adjusted odds ratio 1.50; 95% confidence interval 1.42-2.24; p < .0001). Patients with 25-hydroxyvitamin D insufficiency have an odds ratio for acute kidney injury of 1.49 (95% confidence interval 1.15-1.94; p = .003) and an adjusted odds ratio of 1.23 (95% confidence interval 1.12-1.72; p = .003) relative to patients with 25-hydroxyvitamin D sufficiency. In addition, preadmission 25-hydroxyvitamin D deficiency is predictive of mortality. Patients with 25-hydroxyvitamin D insufficiency have an odds ratio for 30-day mortality of 1.60 (95% confidence interval 1.18-2.17; p = .003) and an adjusted odds ratio of 1.61 (95% confidence interval 1.06-1.57; p = .004) relative to patients with 25-hydroxyvitamin D sufficiency. Conclusion: Deficiency of 25-hydroxyvitamin D prior to hospital admission is a significant predictor of acute kidney injury and mortality in a critically ill patient population.
Background: Vitamin D is part of many physiological functions in the body. This is enough reason to optimise vitamin D level in the body. Studies have linked vitamin D deficiency to the development of Gestational Diabetes Mellitus (GDM). We aimed to compare Vitamin D levels in GDM and Non GDM pregnant women at King Abdulaziz University Hospital Jeddah, Kingdom of Saudi Arabia. Methods: This cross-sectional study was conducted at Obstetrics and Gynaecology outpatient clinic and inpatient obstetrics ward at King Abdulaziz University hospital, Jeddah, Saudi Arabia from January to April 2016. 92 subjects who fulfilled the inclusion criteria were enrolled in the study. Results: Vitamin D level in both the GDM & non GDM groups showed no statistically significant difference. All the 92 female patients were distributed into four quartiles depending on vitamin D level. ,30.4% of quartile 4 was GDM while 47.8 % of quartile 1 was GDM with no statistical significance. The mean age in the GDM group was 31.9?4.8 and in the non GDM was 26.9?5.6 which was statistically significant (p=0.001). The mean score of BMI in GDM group was 32.3?5.8 and non GDM was 28.3?5.5 which was statistically significant (p=0.002). No statistically significant difference was found among the two groups as per the following parameters: Gestational Age (GA), gravity & parity. Conclusion: We found no statistical difference between the GDM and Non GDM groups as regards Vitamin D. Subjects with higher BMI and higher age had significantly higher incidence of GDM. When the results were arranged according to quartiles with lowest vitamin D in quartile 1 and highest vitamin D in quartile 4, we found that the number of GDM cases in the first quartile were double (N=12-47.8%) than the number of GDM cases in the fourth quartile (N=6-30.4%) this difference did not show a statistical significance.
International Journal of Advanced Research, 2017
Background: Vitamin D is part of many physiological functions in the body. This is enough reason to optimise vitamin D level in the body. Studies have linked vitamin D deficiency to the development of Gestational Diabetes Mellitus (GDM). We aimed to compare Vitamin D levels in GDM and Non GDM pregnant women at King Abdulaziz University Hospital Jeddah, Kingdom of Saudi Arabia. Methods: This cross-sectional study was conducted at Obstetrics and Gynaecology outpatient clinic and inpatient obstetrics ward at King Abdulaziz University hospital, Jeddah, Saudi Arabia from January to April 2016. 92 subjects who fulfilled the inclusion criteria were enrolled in the study. Results: Vitamin D level in both the GDM & non GDM groups showed no statistically significant difference. All the 92 female patients were distributed into four quartiles depending on vitamin D level. ,30.4% of quartile 4 was GDM while 47.8 % of quartile 1 was GDM with no statistical significance. The mean age in the GDM group was 31.9±4.8 and in the non GDM was 26.9±5.6 which was statistically significant (p=0.001). The mean score of BMI in GDM group was 32.3±5.8 and non GDM was 28.3±5.5 which was statistically significant (p=0.002). No statistically significant difference was found among the two groups as per the following parameters: Gestational Age (GA), gravity & parity. Conclusion: We found no statistical difference between the GDM and Non GDM groups as regards Vitamin D. Subjects with higher BMI and higher age had significantly higher incidence of GDM. When the results were arranged according to quartiles with lowest vitamin D in quartile 1 and highest vitamin D in quartile 4, we found that the number of GDM cases in the first quartile were double (N=12-47.8%) than the number of GDM cases in the fourth quartile (N=6-30.4%) this difference did not show a statistical significance.
Maternal Vitamin D Status as a Critical Determinant in Gestational Diabetes
Journal of Obstetric, Gynecologic & Neonatal Nursing, 2012
Objective: To synthesize published research to determine the evidence for the association between maternal vitamin D status during pregnancy and the development of gestational diabetes mellitus (GDM). Data Sources: Literature searches were conducted for data based articles that examined maternal vitamin D during pregnancy, GDM, glucose tolerance, and insulin resistance using the PubMed, CINAHL, and SCOPUS data bases and reference lists from reviewed papers. Study Selection: Primary research studies published in the English language between 1999 and 2011 reporting findings regarding the association of vitamin D with glucose homeostasis during pregnancy and GDM. Data Extraction: Study characteristics and findings related to vitamin D status determinants, gestational timing, and measures of glucose homeostasis and insulin resistance. Data Synthesis: Six data based articles met the criteria for study inclusion. Study findings comprised solely Level-2 evidence for the association of maternal vitamin D deficiency and risk of GDM. The majority of studies (66%) were conducted between 24 and 30 weeks gestation. Five (83%) studies reported an inverse relationship between circulating vitamin D levels and markers of glucose homeostasis associated with gestational diabetes or an increased risk for GDM associated with reduced maternal levels of vitamin D. In one study, researchers did not identify an association between vitamin D and GDM but did identify an association between higher vitamin D levels and lower fasting glucose and insulin levels. Conclusion: Maternal vitamin D deficiency and insufficiency is prevalent among gravid women and is associated with markers of altered glucose homeostasis. These findings underscore the need for mechanistic and clinical studies to determine optimal vitamin D status in pregnancy for reduction in the risk for GDM with implications for vitamin D supplementation as a potential target for GDM prevention.
BJOG: An International Journal of Obstetrics & Gynaecology, 2011
Objective To investigate whether maternal serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester are altered in pregnant women with pre-existing type 2 diabetes, women who subsequently develop gestational diabetes mellitus (GDM) and women who deliver large for gestational age (LGA) neonates compared with normoglycaemic pregnant women who deliver an appropriate for gestational age (AGA) neonate. Design Case-control study. Setting Antenatal clinic. Population Singleton pregnancies at 11 +0-13 +6 weeks, including 50 women with type 2 diabetes, 100 women who subsequently developed GDM, 50 nondiabetic women who subsequently delivered LGA neonates and 1000 nondiabetic controls who delivered AGA neonates. Methods Maternal serum total 25(OH)D levels were measured in the four groups of pregnancies. Multiple regression analysis in the controls was used to identify factors among maternal characteristics with a significant contribution to the levels of serum 25(OH)D, so that the values in all cases were expressed as a multiple of the median (MoM) in the controls. Main outcome measures Comparison of MoM 25(OH)D in the four groups. Results In controls, significant independent contributions to the serum level of 25(OH)D were provided by maternal age, body mass index, smoking status, racial origin and season of sampling. The median and interquartile range (IQR) of serum 25(OH)D in the type 2 diabetes group (1.01; IQR, 0.68-1.47 MoM), GDM group (0.93; IQR, 0.67-1.23 MoM) and LGA group (0.97; IQR, 0.67-1.25 MoM) were not significantly different from those in the controls (0.99; IQR, 0.71-1.33 MoM) (overall P = 0.643). Conclusions The first-trimester maternal serum level of 25(OH)D is not altered in women with type 2 diabetes, those who develop GDM or those who deliver LGA neonates.
Association of serum vitamin D levels with gestational diabetes mellitus
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021
Background: This study was done to evaluate the association of serum vitamin D level with GDM (n=30) and without GDM (n=30). The age and body mass index of the participants along with their gestational age, gravidity and parity were harmonized. The serum vitamin D levels and blood glucose were investigated. The results revealed that, normal pregnant women had significantly higher vitamin D level than their GDM counterparts.Methods: This case-control study was conducted on healthy pregnant women attending routine antenatal care at Bangabandhu Sheikh Mujib medical university from January 2019 to December 2019 recruited at third trimester of gestation. We measured maternal serum vitamin D status (25[OH]D) in third trimester of pregnancy. GDM was diagnosed according to the American diabetes association. guidelines. Vitamin D status was defined as, vitamin D sufficiency (≥30 or ≥75 nmol/L), insufficiency (20-30 and 50-75 nmol/L), were used to categories participants according to their 25...
BMC Pregnancy and Childbirth
Background: We investigated the associations between vitamin D status in early and late pregnancy with neonatal small for gestational age (SGA), low birth weight (LBW) and preterm delivery. Furthermore, associations between vitamin D status and pregnancy loss were studied. Methods: Serum 25-hydroxyvitamin D (25OHD) was sampled in gestational week ≤ 16 (trimester 1 (T1), N = 2046) and > 31 (trimester 3 (T3), N = 1816) and analysed using liquid chromatography tandem mass spectrometry. Pregnant women were recruited at antenatal clinics in southwest Sweden at latitude 57-58°N. Gestational and neonatal data were retrieved from medical records. Multiple gestations and terminated pregnancies were excluded from the analyses. SGA was defined as weight and/or length at birth < 2 SD of the population mean and LBW as < 2500 g. Preterm delivery was defined as delivery < 37 + 0 gestational weeks and pregnancy loss as spontaneous abortion or intrauterine fetal death. Associations between neonatal outcomes and 25OHD at T1, T3 and change in 25OHD (T3-T1) were studied using logistic regression. Results: T1 25OHD was negatively associated with pregnancy loss and 1 nmol/L increase in 25OHD was associated with 1% lower odds of pregnancy loss (OR 0.99, p = 0.046). T3 25OHD ≥ 100 nmol/L (equal to 40 ng/ml) was associated with lower odds of SGA (OR 0.3, p = 0.031) and LBW (OR 0.2, p = 0.046), compared to vitamin D deficiency (25OHD < 30 nmol/L, or 12 ng/ml). Women with a ≥ 30 nmol/L increment in 25OHD from T1 to T3 had the lowest odds of SGA, LBW and preterm delivery. Conclusions: Vitamin D deficiency in late pregnancy was associated with higher odds of SGA and LBW. Lower 25OHD in early pregnancy was only associated with pregnancy loss. Vitamin D status trajectory from early to late pregnancy was inversely associated with SGA, LBW and preterm delivery with the lowest odds among women with the highest increment in 25OHD. Thus, both higher vitamin D status in late pregnancy and gestational vitamin D status trajectory can be suspected to play a role in healthy pregnancy.