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Vitamin D bei kritisch kranken Erwachsenen

Vitamin D deficiency in critically ill adults

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Journal für Klinische Endokrinologie und Stoffwechsel Aims and scope

Zusammenfassung

Einleitung und Ziele

Studien der letzten Jahrzehnte brachten neue Erkenntnisse über die Rolle von Vitamin D in einer Vielzahl von Erkrankungen. Momentan wird der Vitamin-D-Mangel als modifizierbarer Risikofaktor für Morbidität und Mortalität bei Intensivpatienten diskutiert. Ziel dieser Arbeit ist es, einen Überblick über die zu dem Thema bisher veröffentlichten Studien und deren Ergebnisse zu geben.

Methoden

Für diese Arbeit wurde die Methode einer Literaturstudie gewählt. Nach relevanter medizinischer Fachliteratur wurde über PubMed gesucht.

Ergebnisse

Es wurden 30 Beobachtungsstudien im ICU-Setting (Intensive Care Unit), vier ICU-Beobachtungsstudien bei Kindern und neun relevante Beobachtungsstudien außerhalb des ICU-Settings gefunden. Seit 2003 wurden in Österreich, Belgien, Australien und den USA neun randomisiert kontrollierte Studien zu Vitamin-D-Supplementation bei kritisch kranken Erwachsenen mit Teilnehmerzahlen zwischen 25 und 475 durchgeführt (gesamt n = 716). In den Interventionsstudien zeigte sich ein relatives Mortalitätsrisiko von 0,69 bis 1,17 (gesamt 0,70).

Schlussfolgerungen

Ein Vitamin-D-Mangel bei kritisch Kranken ist weltweit häufig und mit schlechtem Outcome assoziiert. Bisher gibt es vielversprechende, jedoch heterogene und daher unzulängliche Daten zum potenziellen Benefit einer hochdosierten, kostengünstigen Vitamin-D-Substitution in diesem vulnerablen Kollektiv. Um die vermuteten positiven Effekte einer Vitamin-D-Substitution zu bestätigen, bedarf es dringend großer Phase-III-Interventionsstudien bei kritisch kranken Erwachsenen und Kindern.

Abstract

Introduction

In the last few decades, many new findings have shed light on the role of vitamin D in a number of diseases. Currently, vitamin D deficiency is discussed as a modifiable risk factor for morbidity and mortality in critically ill patients. The aim of this paper is to give a structured overview on the currently available literature in this field and to detect knowledge gaps.

Methods

A literature study was performed. Relevant medical literature was searched mainly through the online database PubMed.

Results

The literature research retrieved 30 observational studies in an intensive care unit (ICU) setting, four observational studies in paediatric ICUs and nine observational studies in a non-ICU-setting. Since 2003, nine randomized controlled trials (RCTs) on vitamin D supplementation in critically ill adults have been carried out in Austria, Belgium, Australia and the USA. The number of participants varied from 25 to 475 (716 in total). The odds ratio (OR) in these RCTs for mortality was calculated between 0.69 and 1.17 (0.70 in total).

Discussion and Conclusion

Vitamin D deficiency in critically ill patients is very common and associated with a poor outcome. Previous studies have shown promising data about a potential benefit of high-dose vitamin D substitution in this vulnerable group. However, the studies and results are heterogeneous, and therefore insufficient to prove a causal relation. Large phase III interventional trials are necessary to confirm the assumed beneficial effects of vitamin D substitution in critical illness.

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Authors and Affiliations

  1. Medizinische Universität Graz, Graz, Österreich

    Elisabeth Altendorfer

  2. Fachbereich Anästhesiologie, Intensiv- und Schmerzmedizin, Krankenhaus der Elisabethinen, Graz, Österreich

    Steven Amrein

  3. Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich

    Karin Amrein

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Correspondence to Elisabeth Altendorfer.

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K. Amrein erhielt Vortragshonorare von Fresenius Kabi, Sinapharm und Siemens. E. Altendorfer und S. Amrein geben an, dass kein Interessenkonflikt besteht.

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Altendorfer, E., Amrein, S. & Amrein, K. Vitamin D bei kritisch kranken Erwachsenen. J. Klin. Endokrinol. Stoffw. 10, 92–101 (2017). https://doi.org/10.1007/s41969-017-0009-0

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