Article Text

PDF

Acute lung injury: what are the causes?
S105 Does vitamin D deficiency increase risk of acute lung injury post oesophagectomy?
  1. R C A Dancer1,
  2. D Park1,
  3. V D'Souza1,
  4. F Gao Smith2,
  5. G D Perkins2,
  6. D R Thickett1
  1. 1University of Birmingham, Birmingham, UK
  2. 2University of Warwick, Warwick, UK

Abstract

Introduction Vitamin D has profound effects on the immune system and its deficiency has been implicated in increased risk of diseases such as tuberculosis and pneumonia. We have shown vitamin D levels to be lower in patients with Acute Lung Injury than in healthy or at risk controls. We hypothesised that vitamin D deficiency may be a risk factor for developing Acute Lung Injury (ALI) following transthoracic oesophagectomy.

Methods 25-OH vitamin D (tandem mass spectrometry) and 1.25-OH vitamin D (ELISA) were measured in plasma samples taken from patients prior to oesophagectomy. IL-6, RAGE and HMGB-1 were measured by ELISA. Extravascular Lung Water (EVLW) measurements were recorded using a PiCCO catheter.

Results All patients undergoing oesophagectomy had insufficient levels of 25-OH vitamin D (<75 nmol/l, median 25.5 nmol/l). 1.25-OH vitamin D levels ranged from 26 to 182 pmol/l (reference range 43–144 pmol/l). Patients who developed ALI more than 72 h post-op had lower levels of 25-Vitamin D (p=0.032). Very low levels of 25-OH vitamin D (<15 nmol/l) were significantly associated with elevated post-operative systemic inflammatory response (as demonstrated by higher plasma levels of IL-6 (p=0.006) and HMGB-1 (p=0.04)) with evidence of increased epithelial damage (elevated RAGE (p=0.03)). Levels of 25 vitamin D3<15 nmol/l were associated with greater post-operative increases in extra vascular lung water (p=0.03). Patients with severe vitamin d deficiency (<20 nmol/l) had a 40% risk of developing post-operative ALI compared to 15% in those with less severe deficiency (p=0.03).

Discussion These results suggest that very low 25 vitamin D levels in oesophagectomy patients are associated with an elevated post-operative systemic inflammatory response, increased alveolar epithelial dysfunction and an increased risk of developing lung injury. These data support the rationale for clinical trials of vitamin D replacement as a preventative therapy for acute lung injury.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.