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1,25-Dihydroxyvitamin D fluctuations in cardiac surgery are related to age and clinical outcome*.

Abstract：

OBJECTIVE:To investigate the interrelationship between cardiac surgery, age, circulating concentrations of the vitamin D hormone 1,25-dihydroxyvitamin D, and clinical outcome. DESIGN:Prospective, monocentric, two-arm parallel study. SETTING:Tertiary Heart and Diabetes Center in the Federal State of North Rhine-Westphalia, Germany. PATIENTS:Twenty-nine cardiac surgical patients aged ≤ 65 yrs and 30 patients ≥ 75 yrs. MEASUREMENTS: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. RESULTS: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). CONCLUSIONS: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.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Börgermann J,Lazouski K,Kuhn J,Dreier J,Schmidt M,Gilis-Januszewski T,Knabbe C,Gummert JF,Zittermann A

doi

10.1097/CCM.0b013e31824e8c42

subject

Has Abstract

pub_date

2012-07-01 00:00:00

pages

2073-81

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

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1,25-Dihydroxyvitamin D fluctuations in cardiac surgery are related to age and clinical outcome*.