Vitamin D supplementation in the ICU does not improve outcomes [VITdAL-ICU trial]

1. Vitamin D supplementation did not change length of ICU or hospital stay among individuals with vitamin D deficiency in this randomized controlled study.

2. The risk of hospital mortality was lower among individuals receiving vitamin D replacement, but there was no mortality benefit at 6 months.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Vitamin D deficiency has been found to be a risk factor for morbidity and mortality. The role of vitamin D supplementation is controversial and different studies have produced discordant results. The effect of vitamin D supplementation in vitamin D deficient critically ill individuals is unknown. This study randomized 492 individuals in intensive care units (ICUs) to receive a high loading dose of vitamin D and, starting 28 days later, five monthly maintenance doses or placebo. The primary outcome was length of hospital stay from the loading dose of vitamin D. At 6 months, 475 individuals were analyzed and 42% were found to have severe vitamin D deficiency (defined as 12 ng/mL or lower).

In summary, the length of ICU and hospital stay was not significantly different between the two groups. In the subgroup with severe vitamin D deficiency, there was a significantly lower risk of hospital death among those in the vitamin D group when compared to the placebo group (HR 0.56, 95%CI 0.35-0.90). There was no difference between the two groups in terms of 6-month survival. Strengths of this study include the long follow-up and the enrollment of patients from different types of ICUs with a variety of medical problems. This study is limited by the fact that all of the patients came from a single tertiary center and were fairly demographically homogeneous. While this study does not show a significant benefit associated with correcting vitamin D deficiency in critically ill patients, a larger study should be done to further investigate the role of vitamin D supplementation among critically ill patients with vitamin D deficiency.

Click to read the study in JAMA

Relevant Reading: Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies

In-Depth [randomized, controlled study]: This study randomized 492 individuals in ICUs to receive a high loading dose of vitamin D (540,000 IU) and 5 maintenance doses of 90,000 IU per month for the following 5 months or placebo. Hospital stay, in hospital mortality, and 6 month mortality were compared in the 475 individuals who were analyzed at the conclusion of the study. Approximately 42% of individuals were found to have severe vitamin D deficiency (≤12 ng/mL). The length of hospital stay (20.1 days for vitamin D vs. 19.3 days for placebo) was not statistically significantly different between the two groups. In hospital mortality (p=0.80) and 6-month mortality (p=0.09) also did not differ significantly between the two groups. The subgroup of patients with severe vitamin D deficiency who received vitamin D supplementation had significantly lower in hospital mortality (HR 0.56, 95%CI 0.35-0.90), but there was no difference in 6-month survival.

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