Study of Vitamin D Deficiency in Inpatients Admitted with Chronic Diseases at Ain Shams University Hospital

Abstract

Vitamin D deficiency among hospitalized patients may be more widespread than realized. Vague musculoskeletal complaints in these chronically ill patients may be attributed to multiple underlying disease processes rather than a deficiency in vitamin D. However, the failure to diagnose an underlying deficiency places the patient at risk for continued pain, weakness, secondary hyperparathyroidism, osteomalacia, and fractures. Elderly hospitalized patients with ionized hypocalcemia and hypophosphatemia, with or without an elevated parathyroid hormone level, are most likely deficient in vitamin D. The aim of this study is to investigate the prevalence of vitamin D deficiency in hospitalized patients and its impact on the length of stay and outcome of hospitalization. Our study was conducted on 80 patients, selected from internal medicine wards of Ain shams university hospitaladmitted between September and December 2016. Patients of both gender, of age more than 18 years old, admitted with acute deterioration of their chronic illness, 20 patients suffering from chronic liver diseases (most of patients were child C on Child-Pugh score), 20 patient with COPD(admitted with infective exacerbation diagnosed by pulmonary function test), 20 patient with cerebrovascular stroke (most of patients with middle cerebral artery occlusion diagnosed by C.T brain) and 20 patient with heart failure (most of patients with ejection fraction <35% diagnosed by echocardiogram) were recruited. We exclude patients admitted with diagnoses other than our four selected disease groups. Also patients admitted to surgery or gynecological departments were excluded. All participants were subjected to full medical history taking, General clinical examination and Laboratory investigations including (25 hydroxy vitamin D level, alkaline phosphatase level, corrected serum calcium, phosphorous, CBC, liver profil, renal profile tests and arterial blood gases). After measurement of vitamin D level, the patients were classified according to their vitamin D status into: deficient group (vitamin D level < 15 ng/ml), insufficient group (vitamin D level from 15 to 29 ng/ml), sufficient group (vitamin D level > 30ng/ml). Our results revealed thatVitamin D level had a highly significant inverse correlation with length of hospital stay (r= -0.648) (p= <0.001). In vitamin D deficient and insufficient groups there was a highly significant inverse correlation with outcome of hospital admission (r=-4.952) (p= <0.001), (t=-4.314) (p=<0.001) respectively. Vitamin D level had a highly significant inverse correlation with alkaline phosphatase level with (r=-0.701) (p=<0.001). Females had a lower vitamin D level than males with a significant difference in deficient group (p= 0.043) and highly significant difference in insufficient group (p= 0.001). On comparing corrected serum calcium with vitamin D level there was a non-significant results (p= 0.411). On comparing CBC, liver and renal profiles between different vitamin D state subgroups we found non-significant difference. We couldn’t find a difference between the different etiologies of hospitalization as regard vitamin D level. In conclusion we found that, vitamin D deficiency and insufficiency are significantly associated with a longer hospital stay and a poor outcome of hospital admission.