Low Vit D Levels: More postop infections

[EMEDPA]

interesting study:

Vitamin D Levels, Hospital Infections Linked
Published: Nov 27, 2013
By Cole Petrochko, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points
Preoperative vitamin D blood levels were significantly and inversely associated with risk for hospital-acquired infections after gastric bypass surgery.
Note that the results suggest that preoperative vitamin D levels may be a modifiable risk factor for postoperative nosocomial infections.
Preoperative vitamin D blood levels were significantly and inversely associated with risk for hospital-acquired infections after gastric bypass surgery, researchers found.

Among obese patients with 25-hydroxyvitamin D levels lower than 30 ng/mL, there was a three-fold risk for a hospital-acquired infection after surgery versus patients whose vitamin D levels were 30 ng/mL or higher (adjusted odds ratio 3.05, 95% CI 1.34-6.94, according to Sadeq Quraishi, MD, of Massachusetts General Hospital (MGH) in Boston, and colleagues.

[discogenic]

From the same group:

http://www.ncbi.nlm.nih.gov/pubmed/23787198  Low vitamin D associated with increased all-cause mortality and infection.

 

http://www.ncbi.nlm.nih.gov/pubmed/21926604 Similar findings in critical care setting

 

They are big into vitamin D and cancer also.

 

Cool stuff.

[jdenning]

I check vitamin d levels on almost everyone because Levels are almost always low in patients with any chronic disease or taking certain kinds of medications ( mostly anticonvulsants in my case). the trick is making sure you've hot an acceptable diagnosis code to check- most insurers won't cover the cost of the test without an osteopenia or osteoporosis code...

[discogenic]

I check vitamin d levels on almost everyone because Levels are almost always low in patients with any chronic disease or taking certain kinds of medications ( mostly anticonvulsants in my case). the trick is making sure you've hot an acceptable diagnosis code to check- most insurers won't cover the cost of the test without an osteopenia or osteoporosis code...

For those not in the osteopenia/osteoporosis risk category, is there a workaround to get the D test paid for?  Are you making any particular D supplementation recommendations for those you don't test?

[EMEDPA]

my pcp (in the pacific nw) does not test anyone and just assumes EVERYONE here is low and recommends an otc daily supplement. I work nights and sleep days so know I would be low without a supplement.

[eliyoussefi]

my pcp (in the pacific nw) does not test anyone and just assumes EVERYONE here is low and recommends an otc daily supplement. I work nights and sleep days so know I would be low without a supplement.

 

This is what I do, unless you've got horrible osteoporosis and we want to push a high dose of vitamin D and correct a very low level, then I check.

[discogenic]

What dosages are you taking/recommending?

[EMEDPA]

my personal regimen

wintertime 5000/day

remainder of the year 4000/day

[eliyoussefi]

my personal regimen

wintertime 5000/day

remainder of the year 4000/day

this and or just give them 52 50000/week and be done with refill request for the year

[UGoLong]

We usually check and give 6-8 weeks at 50,000 units per week, and an ongoing 2000 units daily.

[discogenic]

Prescription vitamin D2 is way more expensive than OTC D3 and arguably the less preferred form.  But I guess it's easier to just prescribe this than to leave it to patients and/or stock and sell your own product (does anyone even do this?).   

[UpRegulated]

Interesting Dec.6 write-up in The Lancet, raising the question (based on recent research) of whether low vitamin D levels are the result of illness, rather than the other way around.  I.e. it could be that those with increased rates of post-op infections are more susceptible due to immune dysfuncton related to chronic or acute illness, and that low vitamin D is merely an indicator, rather than a cause, of that.

 

http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2813%2970164-5/fulltext

[discogenic]

Interesting Dec.6 write-up in The Lancet, raising the question (based on recent research) of whether low vitamin D levels are the result of illness, rather than the other way around.  I.e. it could be that those with increased rates of post-op infections are more susceptible due to immune dysfuncton related to chronic or acute illness, and that low vitamin D is merely an indicator, rather than a cause, of that.

 

http://www.thelancet.com/journals/landia/article/PIIS2213-8587%2813%2970164-5/fulltext

 

Although it's just showing up in the Lancet now, it's not a new idea.  A guy named Trevor Marshall has been promoting this idea for years now, although it hasn't gotten much traction.  You can google 'Marshall Protocol' if interested.  Much of the vitamin D literature is observational/epidemiological, and we need more interventional trials.  But there are interventional trials out there that show benefit, so I'm not sure vitamin D is simply a disease marker.