ÖZET
Amaç:
Vitamin D’nin kardiyak, renal ve endokrin hastalıklardaki etkileri yoğun bakım ünitelerinde morbitide ve mortalite ile yakından ilişkilidir. Vitamin D seviyesinin 20 ng mL-1 altında olması ciddi yetersizlik olarak kabul edilmektedir. Bu çalışmada 75 yaş üstündeki orta ve ileri yaşlı yoğun bakım hastalarının D vitamini seviyeleri arasında farklılık ve her iki grupta yaş ile D vitamin düzeyleri arasında ilişki olup olmadığı araştırıldı.
Yöntemler:
Bu çalışma retrospektif, girişimsel olmayan, ilaç dışı, gözlemsel bir klinik çalışma olarak tasarlanmıştır. Yoğun bakım ünitesine giriş sırasındaki yaş, cinsiyet, D vitamini, akut fizyoloji ve kronik sağlık değerlendirmesi II (APACHE II) ve sıralı organ yetmezliği değerlendirmesi skorları kaydedildi.
Bulgular:
Hastaların 60’ı kadın, 31’i erkekti. Ortalama yaş 77,7±13,8 idi. Doksan bir hastanın 29’u, 75 yaş altı; 62’si 75 yaş ve üzerindeydi. Tüm hastalar incelendiğinde D vitamini ortalama değeri 13,7510 ng mL-1 bulundu.Yetmiş beş yaş üstü hasta grubunda APACHE II skoru ortalaması, 75 yaş altı hasta grubundan anlamlı olarak yüksekti (p=0,024). Yetmiş beş yaş ve üstü grubunda; yaş ile D vitamini düzeyleri arasında anlamlı negatif ilişki vardı (p=0,042).
Sonuç:
Yetmiş beş yaş ve üstü grubunda; yaş ile D vitamini düzeyleri arasında anlamlı negatif ilişki vardı (p=0,042).
References
1
WHO. The uses of epidemiology in the study of the elderly. Technical Rep S 1984; 706: 8-9.
2
Joshi A, Bhadade R, Varthakavi PK, DeSouza R, Bhagwat NM, Chadha MD, et al. Vitamin D deficiency is associated with increased mortality in critically ill patients especially in those requiring ventilatory support. Indian J Endocrinol Metab 2014; 18: 511-5.
3
Amrein K, Schnedl C, Berghold A, Pieber TR, Dobnig H. Correction of vitamin D deficiency in critically ill patients-VITdAL@ICU study protocol of 46 a double-blind, placebo-controlled randomized clinical trial. BMC Endocr Disord 2012; 12: 27.
4
Ucar F, Taslıpınar MY, Soydas AO, Ozcan N. Ankara Etlik İhtisas Eğitim ve Araştırma Hastanesine Başvuran Hastalarda 25-OH vitamin D Düzeyleri. Eur J Basic Med Sci 2012; 2: 12-5.
5
Meehan M, Penckofer S. The role of vitamin D in the aging adult. J Aging Gerontol 2014; 2: 60-71.
6
Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 2009; 19: 73-8.
7
Varkal MA, Yıldız I, Saygili S, Yıldız M, Kılıç A, Darendeliler F, et al. One of the risk groups for vitamin d deficiency: health workers. J Ist Faculty Med 2015; 78: 2.
8
Biricik E, Güneş Y. Vitamin D ve Anestezi. Turk J Anaesth Reanim 2015; 43: 269-73.
9
Holick MF, Biancuzzo RM, Chen TC, Klein EK, Young A, Bibuld D,
et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008; 93: 677-81.
et al. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008; 93: 677-81.
10
Lee P. Vitamin D metabolism and deficiency in critical illness. Best Pract Res Clin Endocrinol Metab 2011; 25: 769-81.
11
Sauneuf B, Brunet J, Lucidarme O, du Cheyron D. Prevalence and risk factors of vitamin D deficiency in critically Ill patients. Inflamm Allergy Drug Targets 2013; 12: 223-29.
12
Lavie CJ, Lee JH, Milani RV. Vitamin D and cardiovascular disease: will it live up to its hype? J Am Coll Cardiol 2011; 58: 1547-56.
13
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 2006; 84: 18-28.
14
Girgis CM. Vitamin D and muscle function in the elderly: the elixir of youth? Curr Opin Clin Nutr Metab Care 2014; 17: 546-50.
15
Gani LU, How CH. PILL Series. Vitamin D deficiency. Singapore Med J 2015; 56: 433-7.
16
Mert O, Kritik Hastada D. Vitamini Metabolizması ve Eksikliği. Turk Klin J Intensive Care-Spec Top 2017; 3: 41-6.
17
Botros RM, Sabry IM, Abdelbaky RS, Eid YM, Nasr MS, Hendawy LM. Vitamin D deficiency among healthy Egyptian females. Endocrinol Nutr 2015; 62: 314-21.
18
Ginde AA, Liu MC, Camargo CA Jr. Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med 2009; 169: 626-32.
19
Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357: 266-81.
20
Zittermann A. Vitamin D and disease prevention with special reference to cardiovascular disease. Prog Biophys Mol Biol 2006; 92: 39-48.
21
Lee JH, O’Keefe JH, Bell, D, Hensrud DD, Holic MF. Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol 2008; 52: 1949-56.
22
Her, C, Greulich T, Koczulla RA, Meyer S, Zakharkina T, Branscheidt M,
et al. The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer. Respir Res 2011;12:31.
et al. The role of vitamin D in pulmonary disease: COPD, asthma, infection, and cancer. Respir Res 2011;12:31.
23
Vacek JL, Vanga SR, Good M, Lai SM, Lakkireddy D, PharmD H. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol 2012; 109: 359-63.
24
Laaksi I, Ruohola JP, Mattila V, Auvinen A, Ylikomi T, Pihlajamäki H. Vitamin D supplementation for the prevention of acute respiratory tract infection: a randomized, double-blinded trial among young Finnish men. J Infect Dis 2010; 202: 809-14.
25
Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 2007; 167: 1730-7.
26
Van den Berghe G, Van Roosbroeck D, Vanhove P, Wouters PJ, De Pourcq L, Bouillon R. Bone turnover in prolonged critical illness: effect of vitamin D. J Clin Endocrinol Metab 2003; 88: 4623-32.
27
Lee P, Eisman JA, Center JR. Vitamin D deficiency in critically ill patients. N Engl J Med 2009; 360: 1912-4.
28
Quraishi SA, Bittner EA, Blum L, McCarthy CM, Bhan I, Camargo Jr CS. Prospective study of vitamin D status at initiation of care in critically ill surgical patients and risk of 90-day mortality. Crit Care Med 2014; 42: 1365-71.
29
Arnson Y, Gringauz I, Itzhaky D, Amital H. Vitamin D deficiency is associated with poor outcomes and increased mortality in severely ill patients. QJM 2012; 105: 633-9.
30
Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006; 81: 353-73.
31
Krishnan A, Ochola J, Mundy J, Jones M, Kruger P, Duncan E, et al. Acute fluid shifts influence the assessment of serum vitamin D status in critically ill patients. Crit Care 2010; 14: 216.
32
Mekov E, Slavova Y, Tsakova A, Genova M, Kostadinov D, Minchev D,
et al. Vitamin D deficiency and insufficiency in hospitalized COPD patients. PLOS ONE 2015;10:e0129080.
et al. Vitamin D deficiency and insufficiency in hospitalized COPD patients. PLOS ONE 2015;10:e0129080.
33
Sağlık Bakanlığı TC. Sağlıkta Kalite ve akreditasyon daire başkanlığı yoğun bakım hastalık Şiddeti Skorlama sistemi. http://ybs.saglik.gov.tr/apache.html
34
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13: 818-29.
35
Özdemir L. Usage of Scoring Systems in Intensive Care Units. J Hacettepe Univ Faculty of Nursing 2014: 91-100.
36
Rech MA, Hunsaker T, Rodriquez J. Deficiency in 25-hydroxyvitamin D and 30-day mortality in patients with severe sepsis and septic shock. Am J Crit Care 2014; 23: 72-9.
37
Turan A, Hesler BD, You J, Saager L, Grady M, Komatsu R, et al. The association of serum vitamin D concentration with serious complications after noncardiac surgery. Anesth Analg 2014; 119: 603-12.
38
Boucher BJ. The problems of vitamin D insufficiency in older people. Aging Dis 2012; 3: 313-29.
39
Halfon M, Phan O, Teta D. Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty. BioMed Res Int 2015;2015:953241.
40
Vitezova A, Zillikens MC, van Herpt TT, Sijbrands EJ, Hofman A, Uitterlinden AG, et al. Vitamin D status and metabolic syndrome in the elderly: the Rotterdam Study. Eur J Endocrinol 2015; 172: 327-35.
