Efeitos da suplementação de vitamina D em pacientes críticos: revisão sistemática e metanálise

Abstract

Introduction: Low levels of vitamin D are associated with poor prognostic factors in the intensive care unit. Vitamin D supplementation could improve the prognosis of critically ill patients. Methods: A systematic review of the literature was performed using the following electronic databases: PubMed, Cochrane, Medline and Scielo. The following keywords were used: “vitamin D”, “intensive care unit”, “critical care”, “sepsis”, “critical ill” and their respective translations to the Portuguese Medical Subject Headings Terms (Mesh terms). Results: In the end, a meta-analysis was performed using the R. Results statistical programm. It included seven studies that evaluated 752 patients, 472 of which (62.8%) were meales, with ages ranging from 54 to 68.9 years. As for the afore mentioned studies, six of them are prospective, randomized and double-blind; one is open. Among them all, five are unicentric and two are multicentric. The dose of vitamin D ranged from 150,000 IU to 540,000 IU. Its administration route as oral or via nasogastric tube in four studies, one of which used IV route and two studies used the intramuscular route. All studies showed an increase in vitamin D in comparison to baseline levels. Regarding adverse effects, it was evidenced that some mild side effects were present in only two studies. The meta-analysis revealed that vitamin D supplementation in critically ill patients can reduce mortality by 28-30 days. [RR 0.76 (95% CI: 0.57-1.00, p = 0.05)]. Regarding mortality, there was no significant difference between groups between 84 and 90 days [RR 1,09 (95% CI: 0.45-2.62, p = 0.85)], hospital mortality [RR = 0.84 (95% CI: 0.66-1.06, p = 0.14)], length of ICU stay [RR -1.44 (95% CI: -3.19-0.31, p = 0.11)], length of hospital stay [RR -6.46 (95% CI: -13.72-0.80, p = 0.08)] and length of mechanical ventilation [RR -0.91 (95% CI: -2.70-0.88, p = 0.32)]. Conclusion: The present meta analysis showed that vitamin D supplementation in critically ill patients shows a reduction of 28-30 days in mortality. Thus, it is suggested that critical patients with at least 18 years of age should receive a dose > 150.000 UI of vitamin D to profit from this benefit.