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Vitamin D boost fails to help deficient ICU patients

December 11, 2019

By Gene Emery

(Reuters Health) - Curing the vitamin D deficiency of a patient in the intensive care unit (ICU) doesn't improve their odds of survival or recovery, a new study of 1,078 seriously-ill people has concluded.

Critically ill patients who have too little vitamin D are known to be at higher risk for death and morbidity. The new research, reported online in the New England Journal of Medicine, was designed to see if a single enteral dose of 540,000 IU would improve their odds.

It didn't.

Ninety-day mortality was 23.5% in the group that got vitamin D and 20.6% in the group that got a teaspoon or so of placebo liquid instead (P=0.26).

Secondary outcomes such as length of hospital stay, quality of life, and time on mechanical ventilation were also unaffected by the supplementation.

"There had been research suggesting you should do this in this population but there was, pretty definitively, no evidence for the benefit of testing for vitamin D deficiency or treating it," chief author Dr. Adit Ginde, vice chairman of emergency medicine at the University of Colorado School of Medicine, told Reuters Health in a telephone interview.

The treatment "was effective at rapidly correcting the vitamin D deficiency. It just did not have a benefit on clinical patient outcomes," he said.

All of the patients had a 25-hydroxyvitamin D level below 20 ng/ml at enrollment. Vitamin D was administered within 14 hours after the decision was made to send the patient to the ICU. The severity of deficiency at enrollment did not affect the outcomes.

Dr. Ginde and his colleagues are examining the data to see if any subgroups, such as patients with specific types of critical illness or genetic factors, or certain categories of patients, might benefit from supplementation.

"We had a very diverse critical care patient population because we had an all-inclusive approach," he said. The ICU cases included patients with pneumonia, respiratory failure, sepsis, and shock.

"We looked at 90-day mortality. We're also looking at whether those who survived did better in the long term in terms of improved physical and cognitive functioning," he said.

Forty four hospitals were involved in the study, known as VIOLET, which ran from April 2017 through July 2018.

SOURCE: The New England Journal of Medicine, online December 11, 2019.

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