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Korean J Crit Care Med > Volume 31(4); 2016 > Article
Cho: Should We Measure Vitamin D Level?
Vitamin D deficiency (serum 25-hydroxyvitamin D > 10 ng per milliliter) increases the risk of bone fracture and muscle weakness. Vitamin D insufficiency is defined as a serum level of 25-hydroxyvitamin D (25[OH]D3) of 10 to 30 ng per milliliter without obvious clinical disease.[1] During the past decade, the effects of vitamin D insufficiency have been studied in cancer, cardiovascular disease, diabetes mellitus, endocrine disorders and immune dysfunction.[1]
In the Korea National Health and Nutrition Examination Survey, the prevalence of serum 25[OH]D3 < 20 ng per milliliter was 47.3% in males and 64.5% in females.[2] In a pilot study, vitamin D insufficiency in patients admitted to intensive care units in the Daegu metropolitan area comprised 87.8%.[3,4] Short-term and mid-term mortality rates were not associated with vitamin D levels, however.[3.4] Vitamin D plays key roles in immune regulation, infection susceptibility and progression of acute respiratory distress syndrome.[5,6] Many studies have suggested that vitamin D replacement therapy reduces mortality in various diseases. In a meta-analysis, vitamin D supplementation seemed to reduce mortality rates in elderly patients.[7] However, the methods of administering vitamin D varied and we did not find appropriate way of vitamin D therapy.
Clinical outcomes according to vitamin D level have not been determined. Beyond basic research, clinical studies using vitamin D are needed in critical and intensive care medicine. Prospective studies on vitamin D replacement in critically ill patients with vitamin D deficiency are ongoing.[8] Regular monitoring of serum 25[OH]D3 should be considered in severely ill patients.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

References

1. Rosen CJ. Clinical practice. Vitamin D insufficiency. N Engl J Med 2011; 364: 248–54.
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2. Choi HS, Oh HJ, Choi H, Choi WH, Kim JG, Kim KM, et al. Vitamin D insufficiency in Korea--a greater threat to younger generation: the Korea National Health and Nutrition Examination Survey (KNHANES) 2008. J Clin Endocrinol Metab 2011; 96: 643–51.
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3. Kim HJ, Sohn MS, Choi EY. Prevalence and related factors of vitamin D deficiency in critically Ill patients. Korean J Crit Care Med 2016; 31: 300–7.
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4. Ala-Kokko TI, Mutt SJ, Nisula S, Koskenkari J, Liisanantti J, Ohtonen P, et al. Vitamin D deficiency at admission is not associated with 90-day mortality in patients with severe sepsis or septic shock: observational FINNAKI cohort study. Ann Med 2016; 48: 67–75.
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5. Upala S, Sanguankeo A, Permpalung N. Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis. BMC Anesthesiol 2015; 15: 84.
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6. Dancer RC, Parekh D, Lax S, D’Souza V, Zheng S, Bassford CR, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax 2015; 70: 617–24.
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7. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Krstic G, Wetterslev J, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2014; (6):CD007470.
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8. Han JE, Jones JL, Tangpricha V, Brown MA, Brown LA, Hao L, et al. High dose vitamin D administration in ventilated intensive care unit patients: a pilot double blind randomized controlled trial. J Clin Transl Endocrinol 2016; 4: 59–65.
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