Abstract

    Open Access Research Article Article ID: GJMCCR-4-144

    Aggressive Treatment of Vitamin D Deficiency in Hispanic and African American Critically Injured Trauma Patients Reduces Health Care Disparities (Length of stay, Costs, and Mortality) in a Level I Trauma Center Surgical Intensive Care Unit

    L Ray Matthews*, Yusuf Ahmed, Omar Danner, Michael Williams, Carl Lokko, Jonathan Nguyen, Keren Bashan-Gilzenrat, Diane Dennis-Griggs, Nekelisha Prayor, Peter Rhee, Ed W Childs, Kenneth Wilson and William B Grant

    Background: Socioeconomics only account for 18% of all healthcare disparities. Healthcare disparities in the intensive care unit (ICU) have been well documented and persist in spite of previous government and medical interventions. Vitamin D deficiency is the most common nutritional deficiency in the United States and the world. This deficiency has been largely overlooked in the debate on healthcare disparities.

    Hypothesis: We hypothesize that low vitamin D levels (a steroid hormone that activates CD4, a T-cell for immune response) and a low CD4 cell count (a T-cell and a marker of a weak immune system) account for most of these healthcare disparities seen in Hispanic and African American patients. We further hypothesize that aggressive treatment of vitamin D deficiency decreases intensive care unit (ICU) length of stay (LOS), ICU cost, and mortality rate in this patient population.

    Methods: We performed a prospective study of the vitamin D status on 316 Hispanic and African American patients admitted to Grady Hospital SICU from August 2009 to September 2011. The patients were divided into 3 groups: Group 1 was treated with vitamin D 50,000 international units (IU) weekly, orally or nasogastric tube (50,000-400,000 IU) for up to 8 weeks; Group 2 was treated with vitamin D 50,000 IU daily for 5 days (250,000 IU of vitamin D); and Group 3 patients (aggressive treatment) received vitamin D 50,000 IU daily down the nasogastric tube for 7 consecutive days. The injury severity score (ISS) was a mean of approximately 15 in all three groups. There wasn’t ant statistical difference between the three groups in terms of injury severity. A CD4 cell count was measured in a subset of 180 patients to evaluate as a marker for potential immune system compromise or weak immune system. In our surgical intensive care unit, Hispanic and African American patients had lower vitamin D levels and CD4 counts up to 40% lower than Caucasian Americans.

    Results: The mean vitamin D levels for the three groups were as follows: Group 1, 10.22±0.60 ng/ml; Group 2, 13.78±0.72 ng/ml; and Group 3, 15.89±0.87 ng/ml (normal≥ 40 ng/ml). Mean ICU LOS decreased with aggressive treatment of vitamin D deficiency from 13.21±2.04 days in Group 1 to 11.53±2.45 days in Group 2 to 6.3 ±0.79 days in Group 3 (p-value, 0.021). Mean ICU cost also decreased with aggressive treatment of vitamin D deficiency by the following: Group 1, $50,934.25±7, 8776; Group 2, $44,464.50±9,458.50; and Group 3, $24,433.02±2,887.75 (p-value, 0.021). Mortality rate decreased from 11.0% in Group 1 to 9.4% in Group 2 to 6.4% in Group 3 (p-value, 0.486). This trend shows a clinically significant 42% reduction in mortality rate which is clinically significant even though it is not statistically significant. 

    Conclusion: We conclude that a compromised immune state due to low vitamin D status and low CD4 cell count may explain a large percentage of healthcare disparities. Aggressively optimizing serum vitamin D status to ≥ 40 ng/ml may be the one of the most important steps in solving healthcare disparities in the United States. Further studies on low vitamin D levels/low CD4 counts are needed to fully address healthcare disparities.

    Keywords:

    Published on: Apr 27, 2017 Pages: 42-46

    Full Text PDF Full Text HTML DOI: 10.17352/2455-5282.000044
    CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat

    Indexing/Archiving

    Global Views

    Case Reports

    Peertechz Tweets

    Pinterest on GJMCCR

    Google Reviews 11