Dahili yoğun bakım ünitesine kabul edilen kritik hastalarda erken dönemde vitamin D düzeyi değişimi ve buna etki edebilecek faktörler
Özet
In the last decade vitamin D has growing importance because of its pleiotropic, antimicrobial, cardioprotective and immunmodulator effects besides ist role on bone and muscle tissues. In critically ill patients, the pleiotropic effects of vitamin D including its role in immune function are of great interest. In intensive care unit (ICU) sepsis, organ failure, fluid deficit may impact vitamin D levels. The aim of this study is to determine if there is any changes in vitamin d levels between on admission, first, second and third days, and factors that can effect this changes. Patients and Methods: Patients admitted to the internal ICU whom APACHE >15, not have kronic kidney disease, and no have vitamin D replacement therapy were enrolled into the study. At admission, at first, second and third day blood samples were taken and 25 hydroxyvitamin D was measured by HPLC (high pressure liquid cromatography) tecniques. CRP, procalcitonin, fluid balance, diuretic or inotrop therapy were assesed. Changes over time were analysed with variance analysis if normal dispersion, if not Friedman tests. Results: Between March 2014 and December 2014, thirty-one patients enrolled into the study. 17 patients were women and 14 were men. The mean age of patients were 70,1±13,8. The mean age of women and men were respetively 71,7±16,9 and 68,1±8,1. On admission to the ICU, 3 patients have normal vitamin D status (>30 mg/mL), 4 patients have relative insufficiency (20-30 mg/mL) and 24 patients have vitami D deficiency (<20 ng/mL). On admission median vitamin D status was 8,52 (5-37) ng/mL, women and men were respectively 9,2 (5-37) and 7,4 (5-34). On the third day median vitamin D level 8,85 (5-35,1) ng/mL, women have median vitamin D level 8,8 (5-35,1) ng/mL, and men have median 7,1 (5,4-34,8) ng/mL. There was no statistically significant difference between vitamin D levels which measured following days (p=0,553). There were no significant corelation between changes in CRP, procalcitonin, fluid balance, diuretic or inotrop thrapy and daily vitamin D levels (p>0,05). Conclusion: Repeated measurements of early vitamin D do not have significant differences. CRP, procalcitonin, albumin, inotrop or diüretic treatment, fluid balance do not effect early serum vitamin D levels in critical patients.