Preoperative Vitamin D Level Is Associated With Postoperative Delirium After Cardiac Surgery in Patients Over 65 Years of Age
Heart Surg Forum. 2020 May 5;23(3):E264-E269. doi: 10.1532/hsf.2961.
Naim Boran Tumer 1, Atike Tekeli Kunt 2, Serdar Gunaydin 1, Kanat Ozisik 1
Delirium 25% if < 10 ng, 18% if > 10ng
Mortality: 4% if < 10 ng, 2.7% if > 10ng
Items in both categories Cognitive and Trauma-Surgery:
- Cardiac Surgery with low vitamin D increased delirium 1.4X, mortality 1.5X – May 2020
- Delirium 24 percent more likely for each 2.5 ng lower vitamin D (313,000 patients) – Feb 2019
- Dementia risk increased 2.4 X following TBI, even if had not lost consciousness – May 2018
- 5 Traumatic brain injuries resulted in 2.8 X increased risk of dementia – April 2018
- Postoperative cognitive dysfunction 8 X more likely if low vitamin D – March 2018
- Delirium in Hospitalized Older Adults (does not mention low vitamin D relationship) NEJM Oct 2017
- Vitamin D and Glutamine reduced Trauma Center deaths by half – March 2017
- Football Brain injuries prevented by Omega-3 – RCT Jan 2016
- Delirium 2.7 X more likely after hip fracture and low vitamin D – May 2015
- Hospital induced delirium 2X more likely if low vitamin D – April 2015
- Magnesium may be an important way to treat brain trauma
- Vitamin D aided progesterone in reducing traumatic brain injury – RCT Dec 2012
Items in both categories Mortality and Trauma-Surgery:
- Cardiac Surgery with low vitamin D increased delirium 1.4X, mortality 1.5X – May 2020
- Ventilator-associated pneumonia death rate cut in half by Vitamin D injection (300,000 IU) – RCT July 2017
- Low Vitamin D when entering ICU is deadly (acute kidney injury in this case) – Aug 2017
- Increased Hospital, Sepsis deaths if low vitamin D – March 2014
- Vitamin D and Glutamine reduced Trauma Center deaths by half – March 2017
- Half of Swiss emergency patients had low vitamin D: length of stay, mortality, etc. – May 2016
- Chance of dying in hospital cut in half by just 10 ng higher level of Vitamin D – April 2016
- ICU patients 30 percent less likely to die if have enough vitamin D – meta-analysis Nov 2016
- Hospital ICU added high dose vitamin D - malpractice lawsuit costs dropped from 26 million dollars to ZERO - Oct 2016
- Vitamin D and exercise after hip fracture surgery – far fewer deaths – July 2016
- Radio frequency ablation survival doubled with even modest levels of vitamin D – Feb 2016
- ICU death rate reduced 3X when a vitamin D injection changed the PTH – Nov 2015
- Risk of death within 90 days of ICU decreased by 16 percent for 1 nanogram extra vitamin D – June 2014
- ICU survival increased with vitamin D single 540K IU loading dose - JAMA Sept 2014
- Vitamin D intervention increased by 20 percent the survival of critically ill patients- RCT June 2014
- Hospital or ICU death about twice as likely if low vitamin D – March 2014
- 3X more likely to die within 3 months of being in ICU for 2 days if less than 20 ng vitamin D – Sept 2013
- Chance of dying within 1 month of entering hospital is 45 percent higher if low vitamin D – July 2013
- More sepsis deaths when active vitamin D (Calcitrol) was low – May 2013
- Off topic: Use of ICU in month before death has increased to almost 30 pcnt – Feb 2013
- Almost 6X more likely to die after coronary bypass if vitamin D deficient – Dec 2012
- Critically ill 70 percent more likely to die if vitamin D less than 15ng – Jan 2011
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Introduction: Delirium after cardiac surgery is a devastating and important complication. Delirium is defined as "disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment)." In this study, we analyzed the association of preoperative vitamin D levels and postoperative delirium after cardiac surgery in patients over 65 years.
Materials and methods: We retrospectively reviewed the data of 212 adult patients above 65 years of age who underwent isolated coronary artery bypass graft surgery from January 2016 to January 2018. The mean age for Group I was 69.7 ± 7.4 and Group II was 70.6 ± 4.8 years. There were 112 female patients in Group I and 46 female patients in Group II. The patient population was divided into 2 groups based on preoperative serum vitamin D (25-hydroxyvitamin D [25-OHD]) levels (normal range of 25-75nmol/L). Group I included patients with preoperative serum 25-OHD level<25nmol/L. Group II included patients with preoperative serum 25-OHD level ≥25nmol/L.
Results: The incidence of delirium in this study was 30.2%. In this study, 138 patients (65.1%) had preoperative serum 25-OHD levels <25 nmol/L, and 74 patients (34.9%) had preoperative serum 25-OHD levels ≥25 nmol/L. Preoperative serum 25-OHD levels were associated with postoperative delirium after coronary artery bypass graft surgery. Our retrospective study illustrated that a lower preoperative serum level of 25-OHD was associated with postoperative delirium. Our results showed that 65.1% of patients had preoperative serum 25-OHD levels <25 nmol/L, and this was associated with postoperative delirium.
Conclusion: Vitamin D deficiency exacerbates delirium after coronary artery bypass surgery with cardiopulmonary bypass. Whether the effects of vitamin D deficiency during this event represent separate or interrelated activities with cardiopulmonary bypass is an important question to address and prospective randomized studies are necessary to confirm these results.