• Gudrun Maria Jonsdottir, Runar Bragi Kvaran, Sigurbjorg Johanna Skarphedinsdottir, Sigurbergur Karason, Diane Krueger, Douglas B Coursin, Neil Binkley, Andrew N Hoofnagle, Kirk Hogan, Gisli Heimir Sigurdsson, and Martin Ingi Sigurdsson.
• Department of Anesthesia and Intensive Care Medicine, Operational Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
• Acta Anaesthesiol Scand. 2022 Nov 1; 66 (10): 120212101202-1210.

BackgroundDespite multiple studies suggesting that low 25(OH)D-vitamin levels are associated with worse outcomes in critically ill individuals, attempts to mitigate the outcomes by fixed dose enteral supplementation unguided by baseline or target blood levels have been unsuccessful. Since a single measurement of 25(OH)D may not optimally reflect an individual's vitamin D status, we studied the plasma concentration of different vitamin D metabolites and their recovery during and following resolution of acute critical illness.MethodsA prospective observational study including patients 18 years and older admitted to a mixed medical-surgical ICU in Reykjavik, Iceland, located at a high-northern altitude (64° N). Vitamin D metabolites were measured at three timepoints; On admission (S1), 3-5 days following admission (S2) and after recovery from acute illness (median 178 days) (S3). Concentrations of total 25(OH)D-vitamin, cholecalciferol (D3 ), total 24,25(OH)D-vitamin, vitamin D binding protein (VDBP) were measured with LC-tandem mass spectrometry (LC-MS/MS) and free 25-(OH)D was measured with enzyme-linked immunosorbent assay.ResultsMost individuals were vitamin D deficient when assessed during critical illness, with 25(OH)D-vitamin levels under 30 ng/ml for 37/40 individuals at timepoint S1 and 34/38 at S2. After recovery, 18/30 patients were deficient at S3. Levels of all vitamin D metabolites measured were low during critical illness but rose substantially following resolution of acute illness. No strong correlation was found between markers of acute illness severity or duration and resolution of vitamin D metabolites in the interval between acute illness and recovery.ConclusionsIn critically ill patients, levels of multiple vitamin D metabolites are low but substantial recovery occurs following resolution of acute illness. It is unclear whether a single metabolite is sufficient to assess vitamin D status of critically ill patients and guide potential supplementation.© 2022 Acta Anaesthesiologica Scandinavica Foundation.

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