Correlation of High Dose of Vitamin D3 with Increased Hemoglobin in Patients under Mechanical Ventilation in Medical ICU

Saraa Salarian ¹ ( Shahid Beheshti University of Medical Sciences, Tehran, Iran )
Seyed Pouzhia Shojaei ² ( Anesthesia and Critical Care Department,Critical Care Quality Improvement Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Science )
Mehran Kouchek ³ ( Anesthesia and Critical Care Department,Critical Care Quality Improvement Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Science )
Mir Mohammad Miri ⁴ ( Anesthesia and Critical Care Department,Critical Care Quality Improvement Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Science )
Mohammad Sistanizad ⁵ ( Department of Clinical Pharmacy,School of Pharmacy, Shahid Beheshti University of Medical Sciences )
Amin Sahranavard ⁶ ( Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran )
Tahere Sorbi ⁷ ( Anesthesiology Research Center, Iran University of Medical Sciences, Tehran, Iran )

Submited date : 2023-02-28 Accepted date : 2024-02-19

Keywords: Vitamin D3, Hemoglobin concentration, Mechanical ventilation,

Abstract :

Anemia is very common in critical illnesses. Around two-thirds of adults are anemic when admitted to the intensive care unit (ICU). Recently, Vitamin D deficiency has been identified as a potential cause of inflammatory anemia. In this study, we examine the relationship between the injection of a high dose of vitamin D3 and the hemoglobin level in patients undergoing mechanical ventilation in the ICU unit. The present study is a double-blind clinical trial. During a six-month period (June to November 2018), all patients admitted to the ICU department of Imam Hossein Hospital who met the study's inclusion criteria and were under mechanical ventilation were randomly divided into two groups. At first, the concentration of hemoglobin and the level of vitamin D3 were checked. In the control group, a placebo was used, while in the intervention group, patients were administered vitamin D3 via gavage (50,000 units for 5 days). The hemoglobin levels were measured and recorded once a week for a maximum duration of one month. No statistically significant difference was observed between the two groups in terms of demographic variables and SOFA. The average hemoglobin levels before and after the study in the vitamin D3 group were 9.9 ± 2.1 and 11.2 ± 2.5, respectively, and the difference was statistically significant (P=0.004). While in the control group, the average hemoglobin levels before and after the study were 9.9 ± 2.1 and 10.2 ± 1.8, respectively. However, the difference was not found to be statistically significant (P=0.102). In this study, it was found that increasing the level of vitamin D3 in patients hospitalized for 6 months in the ICU significantly increased their hemoglobin levels.

References:

. Corwin H.L., Gettinger A., Pearl R.G., 2004. The CRIT Study: Anemia and blood transfusion in the critically ill--current clinical practice in the United States. Crit Care Med. 32(1), 39–52.
2. Vincent J.L., Baron J.F., Reinhart K., 2002. Anemia and blood transfusion in critically ill patients. JAMA. 288(12), 1499–1507.
3. Perlstein T.S., Pande R., Berliner N., Vanasse G.J., 2011. Prevalence of 25-hydroxyvitamin D deficiency in subgroups of elderly persons with anemia: association with anemia of inflammation. Blood. 117(10), 2800–2806.
4. Smith E.M., Alvarez J.A., Martin G.S., Zughaier S.M., Ziegler T.R., Tangpricha V., 2015. Vitamin D deficiency is associated with anaemia among African Americans in a US cohort. Br J Nutr. 113(11), 1732–1740.
5. Dejam A., Malley B.E., Feng M., 2014. The effect of age and clinical circumstances on the outcome of red blood cell transfusion in critically ill patients. Crit Care. 18(4), 487.
6. Retter A., Wyncoll D., Pearse R., et al, 2013. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol. 160(4), 445-464.
7. Weiss G., Goodnough L.T., 2005. Anemia of chronic disease. N Engl J Med. 352, 1011–1023.
8. Bacchetta J., Zaritsky J.J., Sea J.L., 2014. Suppression of iron-regulatory hepcidin by vitamin D. J Am Soc Nephrol. 25(3), 564–572.
9. Smith E.M., Alvarez J.A., Kearns M.D., 2016. High-dose vitamin D3 reduces circulating hepcidin concentrations: A pilot, randomized, double-blind, placebo-controlled trial in healthy adults. Clin Nutr. S0261-5614 (16)30, 148-0.
10. Jeng L., Yamshchikov A.V., Judd S.E., 2009. Alterations in vitamin D status and anti-microbial peptide levels in patients in the intensive care unit with sepsis. J Transl Med. 7, 28.
11. Kempker J.A., West K.G., Kempker R.R., 2015. Vitamin D status and the risk for hospital-acquired infections in critically ill adults: a prospective cohort study. PLoS One. 10(4), e0122136.
12. Amrein K., Schnedl C., Holl A., 2014. Effect of high-dose votamin D3 on hospital length of stay in critically ill patients with vitamin D deficiency: the VITdAL-ICU randomized clinical trial. JAMA. 312(15), 1520–1530.
13. Shailaja J.H., Tyler J.A., Timothy R.W., Erik R.S., 2012. Anemia in Critical Illness Insights into Etiology, Consequences, and Management. Am J Respir Crit Care Med. 15; 185(10), 1049–1057.
14. Ellen M.S., Jennifer L.J., Jenny E.H., Jessica A.A., John H.S., Robert J.K., 2018. High-Dose Vitamin D3 Administration is Associated with Increases in Hemoglobin Concentrations in Mechanically Ventilated Critically Ill Adults: A Pilot Randomized Placebo-Controlled Trial. JPEN J Parenter Enteral Nutr. 42(1), 87–94.
15. Lee L.L., Yong M.N., Pei S.K., Soo K.N., 2018. Association between serum 25 hydroxyvitamin D and glycated hemoglobin levels in type 2diabetes patients with chronic kidney disease. J Diabetes Investig. 9, 375–382.
16. Kim Y.L, Kim H., Kwon Y.E., Ryu D.R., Lee M.J., Park K.S., Ryu H.J., Park J.T., Oh H.J., Han S.H., Yoo T.H., Kang S.W., 2016. Association between Vitamin D Deficiency and Anemia in Patients with End-Stage Renal Disease: A Cross-Sectional Study. Yonsei Med J. 57(5), 1159-64.
17. Strippoli G.F., 2010.Clinical Evaluation of the DOse of Erythropoietins Study Group (C.E. DOSE). Effects of the dose of erythropoiesis stimulating agents on cardiovascular events, quality of life, and health-related costs in hemodialysis patients: the clinical evaluation of the dose of erythropoietins (C.E. DOSE) trial protocol. Trials. 9, 11, 70.
18. Liu T., Zhong S., Liu L., Liu S., Li X., Zhou T., Zhang J., 2015. Vitamin D deficiency and the risk of anemia: a meta-analysis of observational studies. Ren Fail. 37(6), 929-34.
19. Basutkar R.S., Tsundue T., Siva H., Rose A., Ponnusankar S., Mishra S., 2018. Vitamin D supplementation in patients with iron deficiency anemia: a systematic review and a meta-analysis. Syst Rev Parm. 1,172-174.