Vitamin D and Postoperative Delirium After Coronary Artery Bypass Grafting: A Prospective Cohort Study.

OBJECTIVE: Postoperative delirium is the most common neuropsychiatric complication after cardiac surgery. Vitamin D contributes to numerous brain processes, regulation of neurotrophic factors, neuroprotection, neuroplasticity, and brain development, which could play a role in delirium pathophysiology. The authors evaluated the association of admission serum levels of 25-hydroxyvitamin D [25(OH)D] with the occurrence of delirium after coronary artery bypass surgery. DESIGN: A prospective cohort study. SETTING: University hospital. PARTICIPANTS: Coronary artery bypass surgery patients. MEASUREMENTS AND MAIN RESULTS: Serum levels of 25(OH)D were measured for 398 patients upon admission. Delirium was measured using the confusion assessment method for the intensive care unit. RESULTS: Postoperative delirium was detected in 17% (n = 68) of the patients. 25(OH)D deficiency (less than 20 ng/dL) was found in 41.2% (n = 164) of the patients. The median serum level of 25(OH)D was 21 ng/dL (12.8-32.85) in delirium and 24.2 ng/dL (14.4-42.5) in nondelirium patients (p = 0.04). Multivariate regression analysis adjusted by other risk factors indicated that admission severe hypovitaminosis D was associated with the occurrence of delirium (odds ratio = 3.18; 95% confidence interval: 1.29-7.78; p = 0.01). CONCLUSIONS: Preoperative severe vitamin D deficiency was associated with the occurrence of delirium after coronary artery bypass grafting surgery.

Association of admission serum levels of vitamin D, calcium, Phosphate, magnesium and parathormone with clinical outcomes in neurosurgical ICU patients.

To evaluate the association of admission serum levels of 25(OH)D, parathormone and the related electrolytes with severity of illness and clinical outcomes in neurosurgical critically ill patients, serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate, along with APACHE II score were measured for 210 patients upon admission. Mean serum 25(OH)D was 21.1 ± 7.4 ng/mL. 25(OH)D deficiency (less than 20 ng/dL) and elevated serum parathormone level were found in 47.6% and 38% of patients respectively. Hypocalcaemia, hypophosphatemia, hypomagnesaemia and hypermagnesaemia were found in 29.5%, %63.8, 41.9% and 27.6% of patients respectively. The APACHE II score was significantly correlated with serum levels of 25(OH)D, parathormone, calcium, and phosphate. Multivariate regression analysis adjusted by other risk factors showed that among all clinical outcomes, admission hypovitaminosis D was associated with longer duration of ICU stay and a high admission of parathormone was associated with in ICU mortality. We concluded that disorders of admission serum levels of 25(OH)D, parathormone, calcium, magnesium, and phosphate are related to the presence of multiple causal factors such as severity of disease and are not independently associated with clinical outcomes. Most often they are normalize spontaneously with resolution of the disease process.