Emerging data have led to the hypothesis that vitamin D plays a role in promoting epithelial barrier dysfunction. Therefore, intestinal permeability becomes a significant determiner in the future of patients hospitalized in intensive care unit (ICU). The relationship between vitamin D and intestinal permeability remains unclear in patients who are critically ill. The aim of the study is to document the relationship between the admission vitamin D deficiency and markers of intestinal permeability in the critical care setting. This was a single-center, observational, prospective study in the general ICU of a university-affiliated hospital. A sample of 144 ICU-hospitalized adult patients was recruited between January and May 2018. The admission serum 25-hydroxyvitamin D levels were measured and categorized as <20 and ≥20 ng/dL, respectively. Moreover, the admission plasma endotoxin and zonulin concentrations as markers of intestinal permeability were determined in stringent conditions. The association between markers of intestinal permeability and 25-hydroxyvitamin D levels was assessed adjusting for potential confounders through an estimation of a binary logistic regression model. Our results showed that median plasma endotoxin and zonulin decreased with increasing serum levels of vitamin D categories (p=0.001) in the overall study population. Multivariate binary logistic regression analyses showed a significant association between the plasma endotoxin (OR 0.12, 95% CI 0.03 to 0.52) and zonulin (OR 0.91, 95% CI 0.87 to 0.99) levels with serum levels of vitamin D categories in the overall population. Our finding suggests a relationship between vitamin D deficiency and early alterations in intestinal permeability. Thus, evaluating vitamin D levels in patients who are critically ill may be warranted.
- 25-hydroxyvitamin D
- intensive care units
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Correction notice This article has been corrected since it was published Online First. The affiliation for Ghazaleh Eslamian has been slightly modified.
Contributors GE, SHA and ZVS conceptualized and designed the study and wrote the manuscript. GE and MHK analyzed the data. GE and SHA collected the data. GE and ZVS interpreted the data and provided professional comments. MHK and SHA critically revised the manuscript for intellectual content and data accuracy. ZVS had responsibility for final content. All authors read and approved the final manuscript.
Funding This study is related to the project number 1397/58549 from the Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran. This study received financial support from the 'Student Research Committee' and the 'Research & Technology Chancellor' in Shahid Beheshti University of Medical Sciences.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the related ethics committee and performed in accordance with the ethical standards proposed in the 1964 Declaration of Helsinki and its later amendments.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.