by Johannes Menger, Zheng-Yii Lee, Quirin Notz, Julia
Wallqvist, M. Shahnaz Hasan, Gunnar Elke, Martin Dworschak, Patrick Meybohm,
Daren K. Heyland and Christian Stoppe
Critical Care volume 26,
Article number: 268 (2022)
Background
The clinical significance of vitamin D administration in
critically ill patients remains inconclusive. The purpose of this systematic
review with meta-analysis was to investigate the effect of vitamin D and its
metabolites on major clinical outcomes in critically ill patients, including a
subgroup analysis based on vitamin D status and route of vitamin D
administration.
Methods
Major databases were searched through February 9, 2022.
Randomized controlled trials of adult critically ill patients with an
intervention group receiving vitamin D or its metabolites were included.
Random-effect meta-analyses were performed to estimate the pooled risk ratio
(dichotomized outcomes) or mean difference (continuous outcomes). Risk of bias
assessment included the Cochrane tool for assessing risk of bias in randomized
trials.
Results
Sixteen randomized clinical trials with 2449 patients were
included. Vitamin D administration was associated with lower overall mortality
(16 studies: risk ratio 0.78, 95% confidence interval 0.62–0.97, p = 0.03; I2 = 30%),
reduced intensive care unit length of stay (12 studies: mean difference − 3.13 days,
95% CI − 5.36 to − 0.89, n = 1250, p = 0.006; I2 = 70%), and
shorter duration of mechanical ventilation (9 studies: mean difference − 5.07 days,
95% CI − 7.42 to − 2.73, n = 572, p < 0.0001; I2 = 54%). Parenteral
administration was associated with a greater effect on overall mortality than
enteral administration (test of subgroup differences, p = 0.04), whereas
studies of parenteral subgroups had lower quality. There were no subgroup
differences based on baseline vitamin D levels.
Conclusions
Vitamin D supplementation in critically ill patients may
reduce mortality. Parenteral administration might be associated with a greater
impact on mortality. Heterogeneity and assessed certainty among the studies
limits the generalizability of the results.
