ROLE OF VITAMIN D SUPPLEMENTATION IN CRITICALLY ILL PATIENTS: AN UPDATED META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Vitamin D deficiency in critically ill patients is common and is associated with an increased risk of respiratory infections and mortality. Randomized controlled trials (RCTs) have reported conflicting results with the use of Vitamin D in such patients. We conducted this updated meta-analysis of RCTs comparing Vitamin D supplementation in critically ill patients. METHODS: We searched electronic databases for RCTs comparing Vitamin D with placebo in critically ill patients admitted to the ICU. Mortality, duration of mechanical ventilation, ICU stay, and length of hospital stay were outcomes of interest. We used random-effects meta-analysis to estimate risk ratio (RR) with a 95% confidence interval (CI) for a dichotomous outcome like mortality. For continuous outcomes, the inverse variance method was used to calculate the standardized mean difference (SMD) with 95% CI. A p-value of 0.05 or less was considered significant. I-squared (I2) statistic assessed heterogeneity between studies, and a value of I2 >50% was considered significant. RESULTS: Eleven RCTs with a total of 2,187 patients (Vitamin D: n = 1,120, Placebo: n = 1,067) were included. A total of 534 deaths (Vit D: n= 260 and placebo: n= 274) out of 2,187 patients were reported. Compared to placebo, Vitamin D supplementation was associated with a numerical decrease in mortality, but the difference was not statistically significant [RR 0.85, 95% CI (0.68, 1.04), p = 0.12]. No significant heterogeneity was noted in the analysis (I2= 26%). Six trials reported the duration of mechanical ventilation, nine trials reported length of ICU stay, and seven trials reported length of hospital stay. Vit D supplementation was associated with decreased duration of mechanical ventilation [SMD -0.50 95% CI (-0.97, -0.03), p= 0.04] and length of ICU stay [SMD -0.60 95% CI (-1.03, -0.16), p=0.007] when compared to placebo. The results were associated with significant heterogeneity I2= 83% for mechanical ventilation and I2=89% for ICU stay. However, the length of hospital stay was similar in both groups [SMD -0.21 95% CI (-0.51, 0.09), p=0.18]. CONCLUSIONS: Vitamin D supplementation in critically ill patients may decrease the duration of ICU stay and mechanical ventilation without affecting overall hospital stay and mortality. CLINICAL IMPLICATIONS: Critically ill patients have an overall poor prognosis and have limited pharmacological options to improve outcomes. This meta-analysis of randomized controlled trials suggests that vitamin D supplementation in critically ill patients decreases the duration of mechanical ventilation and also shortens the stay in intensive care units. While vitamin D was associated with a numerical decrease in mortality, the results failed to reach significance. Future studies should attempt to identify specific subgroups of critically ill patients who will likely benefit the most from vitamin D supplementation. DISCLOSURES: No relevant relationships by Amit Rout, source=Web Response No relevant relationships by Sauradeep Sarkar, source=Web Response No relevant relationships by Sahib Singh, source=Web Response