LB035 - LOW VITAMIN D LEVEL IS COMMON AND NOT CORRECTED BY INTENSIVE STANDARD CLINICAL NUTRITION IN CRITICALLY ILL TRAUMA PATIENTS.

LB035

LOW VITAMIN D LEVEL IS COMMON AND NOT CORRECTED BY INTENSIVE STANDARD CLINICAL NUTRITION IN CRITICALLY ILL TRAUMA PATIENTS.

G. Nardai¹, C. Ferdinandy^2,*, O. Fabian¹

¹Intensive Care Unit, Manninger Jenő Trauma Centre, ²Central Pharmacy, Korányi National Institute of Pulmonology, Budapest, Hungary

Rationale: Deficiency of vitamin D among critically ill patients admitted to intensive care unit is not uncommon. Hypovitaminosis is associated to unfavourable outcome in some populations however, the need and method of regular vitamin D supplementation is not clear.

Aim of our study was to assess hypovitaminosis among critically ill trauma patients and measure the effect of standard clinical nutrition interventions on vitamin D levels during long term clinical nutrition.

Methods: Single centre, prospective, observational study over 1 year period. Only acute, adult, major trauma patients admitted to intensive care unit and possibly requiring long term (at least 2 weeks) clinical nutrition were involved. Demographic and injury parameters, clinical data, co-morbidities, nutritional status (NRS-2002), interventions, method and length of clinical nutrition and outcome parameters were registered. Vitamin D level was measured by central lab (ABBOTT Architect Immunoassay) at admission and day 7,14,28. Statistical analysis: Mann-Whitney test, chi-square test (p<0.05).

Results: We enrolled 57 patients (84% men, median age 51 , median BMI 26). Majority of them suffered moderate-severe brain injury (63%), half of them had major multiple trauma (median ISS: 25). Malnutrition (NRS > 3) at admission was detected in 31%, comorbidities in 72% of patients. Ventilation was needed in 89%, vasopressor support in 73% of patients. Infection was diagnostized in 58% during ICU, median LOS in ICU was 13 days and a 25% mortality was observed. Enteral nutrition was applied in 94%, parenteral in 38% and oral supplementation in 38% of patients. Energy and protein goals were determined by ESPEN guideline and achieved in 82% and 75% of the treatment days. Standard, worldwide accepted formulas were used. Vitamin D level slightly increased by time (38-44-44-53 ng/ml), deficiency was detected in 39%. Vitamin D level increased markedly only in 45% of patients, but deficiency was corrected only in 35% of cases by standard care. An increasing kinetic of Vit D level was associated to less severe patients with better outcome (infection: 50% vs 70%).

Conclusion: Vitamin D deficiency is common among major trauma patients admitted to intensive care unit in a continental trauma centre. Well guided standard clinical nutrition is sufficient to maintain normal vitamin levels, but unable to correct deficiency. Vitamin D therapy might be required in patients admitted with low vitamin D levels and with severe post-admission complications.

Disclosure of Interest: None declared