Vitamin D assessment in perioperative medicine and critical care A prospective observational pilot study

Background There is controversy about the impact of acute illness on vitamin D levels. This study was carried out to assess the influence of perioperative fluid loading on 25-hydroxy-vitamin D [25(OH)D] levels. The study evaluated the clinical utility of a commonly available chemiluminescence assay (ECLIA, IDS-iSYS) and liquid chromatography/mass spectrometry (LC-MS/MS) in the diagnosis of vitamin D deficiency in this setting. Methods In this prospective observational pilot study in adult patients undergoing cardiovascular surgery on cardiopulmonary bypass (CPB), blood samples drawn at preoperative baseline (t1), after weaning from CPB (t2), on intensive care unit (ICU) admission (t3) and on the first (t4) and second (t5) postoperative days were analyzed. Results A total of 26 patients (130 samples) were included in this study. Fluid loading by CPB led to a median reduction of 25(OH)D by -22.6% (range -54.5% to -19.5%) between t1 and t2. Cohen's kappa (kappa) for method agreement for vitamin D deficiency (tested cut-off values 20ng/ml and 12ng/ml), was kappa= 0.291 (p< 0.001) and kappa= 0.469 (p< 0.001), respectively. The mean difference between measurements by ECLIA and LC-MS/MS was 4.8ng/ml (+/- 5.7), Pearson's r for correlation was 0.73 (p< 0.001). The biologically inactive C3-epimer did not contribute to 25(OH)D levels assessed by LC-MS/MS. Conclusion The 25(OH)D measurements by chemiluminescence assays can noticeably deviate from those measured by LC-MS/MS, which can be considered the unequivocal gold standard. These assays may still be acceptably reliable in the screening for vitamin D deficiency, especially in the setting of low vitamin D levels. Stricter definitions, e.g. serum 25(OH)D levels lower than 12ng/ml, may be used to diagnose deficiency with low false positive rate.

Automated summary

This study investigated the impact of perioperative fluid loading on 25(OH)D levels and compared the results of different measurement methods. The results showed a significant decrease in 25(OH)D levels due to perioperative fluid loading, and the consistency of various measurement methods in diagnosing vitamin D deficiency needs further research.