25-hydroxyvitamin-d-2 and Critical-Illness

Topics: 25-Hydroxyvitamin D 2; Aged; Bone Resorption; Critical Care; Critical Illness; Female; Humans; Male; Middle Aged; Peptide Fragments; Procollagen; Prospective Studies

Chronically critically ill (CCI) patients are primarily elderly people who have survived a life-threatening episode of sepsis but remain profoundly debilitated and ventilator dependent. The objective of this study was to determine the prevalence of bone hyperresorption and parathyroid hormone (PTH)-vitamin D axis abnormalities in these patients.. Prevalence survey.. Respiratory care step-down unit (RCU) at a tertiary care teaching hospital.. Forty-nine ventilator-dependent CCI patients transferred from ICUs within the same institution.. None.. N-telopeptide (NTx) levels in 24-h urine collections and serum intact PTH, 25-vitamin D, and 1,25-vitamin D levels were measured within 48 h of RCU admission. Patients were hospitalized a median of 30 days before RCU admission. Four patients (9%) had normal NTx and PTH levels. Forty-five patients (92%) had elevated urine NTx levels consistent with bone hyperresorption. Nineteen patients (42% of total patients) had elevated PTH levels consistent with predominant vitamin D deficiency, 4 patients (9%) had suppressed PTH levels consistent with predominant hyperresorption from immobilization, and 22 patients (49%) had normal PTH levels consistent with an overlap of both vitamin D deficiency and immobilization. There were no differences in vitamin D metabolites among these groups.. CCI patients have a high prevalence of bone hyperresorption in which PTH levels may clarify the cause. Further studies will determine the efficacy and cost-effectiveness of routine NTx and PTH screening in these patients and the role of vitamin D and antiresorptive therapies.

Topics: 25-Hydroxyvitamin D 2; Adult; Aged; Aged, 80 and over; Bed Rest; Biomarkers; Bone Resorption; Calcitriol; Chronic Disease; Collagen; Collagen Type I; Critical Illness; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Parathyroid Hormone; Peptides; Prevalence; Prospective Studies; Respiratory Care Units; Vitamin D Deficiency