calcitriol and Cardiac-Output--Low

To investigate the interrelationship between cardiac surgery, age, circulating concentrations of the vitamin D hormone 1,25-dihydroxyvitamin D, and clinical outcome.. Prospective, monocentric, two-arm parallel study.. Tertiary Heart and Diabetes Center in the Federal State of North Rhine-Westphalia, Germany.. Twenty-nine cardiac surgical patients aged ≤ 65 yrs and 30 patients ≥ 75 yrs.. We assessed 1,25-dihydroxyvitamin D and other biochemical parameters of mineral metabolism (calcium, phosphate, 25-hydroxyvitamin D, and parathyroid hormone), various inflammatory markers (C-reactive protein, interleukin-6 and 8), and different immunological parameters (CD4 and CD8 cells, monocyte HLA-DR expression). We collected blood samples preoperatively, immediately after surgery, and on postoperative days 1, 5, and 30. In addition, we assessed adverse outcome until discharge as a composite of myocardial infarction, low cardiac output syndrome, infection, stroke, or in-hospital death.. There were significant transient cardiac surgery-related fluctuations in 1,25-dihydroxyvitamin D and the aforementioned parameters of mineral metabolism, inflammation, and immune status. Compared to younger patients, older patients had consistently lower 1,25-dihydroxyvitamin D and phosphate levels (p = .013 and p = .036, respectively) and significantly higher interleukin 6 and 8 levels (p = .008 and p < .001, respectively). Circulating 1,25-dihydroxyvitamin D was directly related to glomerular filtration rate (R(2) = .227; p < .001) and inversely related to interleukin 6 (R(2) = .105; p = .012). The rate of adverse outcome tended to be higher in older than in younger patients (20.0% vs. 3.5%; p = .081). In risk score-adjusted logistic regression analysis, adverse outcome risk decreased by 7.7% (SE: 3.7%) for each pmol/L increment in 1,25-dihydroxyvitamin D (p = .037).. Circulating 1,25-dihydroxyvitamin D levels fluctuate in relation to cardiac surgery. Low 1,25-dihydroxyvitamin D levels are associated with inflammatory processes and age-related differences in clinical outcome. Future studies should determine whether therapies aimed at treating low 1,25-dihydroxyvitamin D levels can improve the outcome in older cardiac surgery patients.

Topics: Age Factors; Aged; C-Reactive Protein; Calcium; Cardiac Output, Low; CD4-CD8 Ratio; Coronary Artery Bypass; Female; Glomerular Filtration Rate; Heart Valve Prosthesis Implantation; HLA-DR Antigens; Humans; Intensive Care Units; Interleukin-6; Interleukin-8; Length of Stay; Logistic Models; Male; Middle Aged; Monocytes; Myocardial Infarction; Outcome Assessment, Health Care; Parathyroid Hormone; Phosphates; Prospective Studies; Surgical Wound Infection; Vitamin D