RESUMEN
Vitamin D deficiency appears to be more prevalent than previously considered in the adult critically ill population, and specifically burn-injured patients. No definitive regimen has been shown to restore vitamin D (25(OH)D) levels more effectively to therapeutic levels in the burn-injured population. The purpose of this study was to investigate the effects of either ergocalciferol (D2, 50,000 IU weekly) or cholecalciferol (D3, 6,000 IU daily) in adults with burns ≥ 10% TBSA. This retrospective, observational study (2020-2022) included patients with vitamin D deficiency (< 30 ng/mL) who received replacement and had monitoring with weekly vitamin D levels. Patients on dialysis or those with a hospital length of stay (LOS) less than 2 weeks were excluded. Forty-five patients treated with ergocalciferol and 99 patients with cholecalciferol were included in the study. Patients treated with cholecalciferol were more likely to achieve 25(OH)D levels greater than 30 ng/ml compared to ergocalciferol over a 42-day period (HR 23.56, [95% CI, 12.57-44.16, p<0.0001). A higher proportion of patients in the cholecalciferol group achieved vitamin D greater than 20 ng/ml (HR 6.37, [95% CI, 4.20-9.66, p<0.0001). The adjusted hazard ratios (D3 vs D2) for achieving 25(OH)D levels > 30 ng/ml and > 20 ng/ml were and 23.94 (95% CI 5.09-427.6, p=0.0019) and 7.32 (95% CI 3.83-15.52, p<0.0001) respectively, after controlling for TBSA and initial 25(OH)D. Cholecalciferol appears to be a more effective agent than ergocalciferol for correcting vitamin D deficiency and insufficiency in patients with burn injuries.
RESUMEN
Acute rejection is a major morbidity in heart transplant recipients; diagnosis is difficult, and rejection must often be treated reactively. Various serum biomarkers have been investigated for non-invasive monitoring of the cardiac allograft. NTproBNP is produced by the ventricular myocardium and may increase with evolving rejection allowing earlier diagnosis. Retrospective review of serum NTproBNP levels in pediatric heart transplant recipients has been carried out to evaluate the association with episodes of acute rejection. Repeated measures logistic regression was used to model associations for variables with first rejection and within an individual for change in NTproBNP and first rejection. Odds ratios for rejection risk given an increase in serum NTproBNP were calculated. Correlation of NTproBNP levels with renal function as estimated by modified Schwartz equation was performed to look for confounding. Higher serum NTproBNP level was associated with increased risk of rejection, but intersubject variability was wide. However, increase in an individual subject's serum level showed increased risk of rejection, greater with greater rise. Serum NTproBNP levels appear not greatly affected by renal function. NTproBNP shows promise in surveillance for pediatric heart transplant recipients. The greatest use appears to be in following trends for an individual instead of using an absolute value.
