Vitamin D and burn injury




vitamin D, cholecalciferol, ergocalciferol, vitamin D Deficiency, burns, burn injury, sepsis, review


The Deficiency of vitamin D is common in the gene­ral population. It is also noted in 40–70 % of critical patients in the intensive care units. Vitamin D has a wide range of pleiotropic effects on various processes and systems, including the immune-inflammatory response. Low level of vitamin D in critical patients is associated with more frequent Development of sepsis, respiratory Distress syndrome, multiple organ failure, and increased mortality. The clinical understanding of hypovitaminosis D remains underestimated and therefore is often ignored in acute clinical situations, including burn injury, in which several factors contribute to the Development and long-term maintenance of vitamin D Deficiency. Although studies on the level of vitamin D in burn patients are limited, vitamin D levels have been shown to Decline after thermal injury. Clarification of the current understanding of the role of vitamin D in patients with thermal injury, the effect of vitamin D level on treatment outcomes at Different periods of burn Disease, and the possibility and necessity of correcting of hypovitaminosis D in this category of patients is the goal of this review. The article analyzes the possibility of improving the results of the treatment of burn injury, preventing several complications of burn Disease by correcting the level of vitamin D.


Amrein K., Papinutti A., Mathew E., Vila G., Parekh D. Vitamin D and critical illness: what endocrinology can learn from intensive care and vice versa. Endocrine connections. 2018. 7 (12). R304-R315. Doi: 10.1530/EC-18-0184.

Wood C.L., Cheetham T.D. Vitamin D: increasing supplement use among at-risk groups (NICE guideline PH56). Arch. Dis. Child Educ. Pract. Ed. 2016. 101 (1). 43-5. Doi: 10.1136/archdischild-2015-308299.

Dickerson R.N., Van Cleve J.R., Swanson J.M., Maish G.O. III, Minard G., Croce M.A., Brown R.O. Vitamin D Deficiency in critically ill patients with traumatic injuries Burns & Trauma. 2016. 4 (1). 1-9. Doi:

Lee P. Vitamin D metabolism and Deficiency in critical illness. Best. Pract. Res. Clin. Endocrinol. Metab. 2011. 25 (5). 769-81. Doi: 10.1016/j.beem.2011.03.001.

Quraishi S.A., Camargo C.A. Jr. Vitamin D in acute stress and critical illness. Curr. Opin. Clin. Nutr. Metab. Care. 2012. 15 (6). 625-34. Doi: 10.1097/MCO.0b013e328358fc2b.

Nair P., Lee P., Reynolds C., Nguyen N.D., Myburgh J., Eisman J.A., Center J.R. Significant perturbation of vitamin D-parathyroid-calcium axis and adverse clinical outcomes in critically ill patients. Intensive Care Med. 2013. 39 (2). 267-74. Doi: 10.1007/s00134-012-2713-y.

Czarnik T., Czarnik A., Gawda R., Gawor M., Piwoda M., Marszalski M. et al. Vitamin D kinetics in the acute phase of critical illness: A prospective observational study. J. Crit. Care. 2018. 43. 294-299. Doi: 10.1016/j.jcrc.2017.09.179.

Amrein K., Parekh D., Westphal S., Preiser J., Berghold A., Riedl R. et al. Effect of high-dose vitamin D3 on 28-day mortality in adult critically ill patients with severe vitamin D Deficiency: a study protocol of a multicentre, placebo-controlled Double-blind phase III RCT (the VITDALIZE study). BMJ Open. 2019. 9 (11). e031083. Doi: 10.1136/bmjopen-2019-031083.

Martucci G., Amrein K., Nei J. Vitamin D Deficiency in ICU patients. ICU Management & Practice. 2019. 2. 114-116.

Colotta F., Jansson B., Bonelli F. Modulation of inflammatory and immune responses by vitamin D. J. Autoimmun. 2017. 85. 78-97. Doi: 10.1016/j.jaut.2017.07.007.

Al-Tarrah K., Hewison M., Moiemen N., Lord J.M. Vitamin D status and its influence on outcomes following major burn injury and criti-cal illness. Burns Trauma. 2018. 6. 11. Doi: 10.1186/s41038-018-0113-4.

Rech M.A., Colon Hidalgo D., Larson J., Zavala S., Mo­sier M. Vitamin D in burn-injured patients. Burns. 2019. 45 (1). 32-41. Doi: 10.1016/j.burns.2018.04.015.

Holick M.F. Vitamin D Deficiency. N. Engl. J. Med. 2007. 357 (3). 266-81.

Bouillon R., De Groot L., Jameson J. Vitamin D: from photosynthesis, metabolism, and action to clinical applications. Endocrino­logy. 2001. 1010-1028.

DeLuca H.F. Overview of general physiologic features and functions of vitamin D. Am. J. Clin. Nutr. 2004. 80 (6). 1689-1696.

Christakos S., Dhawan P., Verstuyf A., Verlinden L., Carmeliet G. Vitamin D. Metabolism, Molecular Mechanism of Action, and Plei-otropic Effects. Physiol. Rev. 2016. 96 (1). 365-408. Doi: 10.1152/physrev.00014.2015.

Rousseau A.F., Damas P., Ledoux D., Cavalier E. Effect of cholecalciferol recommended Daily allowances on vitamin D status and fibro-blast growth factor-23: an observational study in acute burn patients. Burns. 2014. 40 (5). 865-70. Doi: 10.1016/j.burns.2013.11.015.

Rousseau A.F., Damas P., Ledoux D., Lukas P., Carlisi A., Le Goff C., Gadisseur R., Cavalier E. Vitamin D status after a high Dose of cholecalciferol in healthy and burn subjects. Burns. 2015. 41 (5). 1028-1034. Doi: 10.1016/j.burns.2014.11.011.

Rousseau A.F., Foidart-Desalle M., Ledoux D., Remy C., Croisier J.L., Damas P., Cavalier E. Effects of cholecalciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength and bone health: a one-year pilot randomized controlled trial in adults with severe burns. Burns. 2015. 41 (2). 317-25. Doi: 10.1016/j.burns.2014.07.005.

Gentile L.F., Cuenca A.G., Efron P.A., Ang D., Bihorac A., McKinley B.A., Moldawer L.L., Moore F.A. Persistent inflammation and im-munosuppression: a common syndrome and new horizon for surgical intensive care. J. Trauma Acute Care Surg. 2012. 72 (6). 1491-501. Doi: 10.1097/TA.0b013e318256e000.

Orford N., Cattigan C., Brennan S.L., Kotowicz M., Pasco J., Cooper D.J. The association between critical illness and changes in bone turnover in adults: a systematic review. Osteoporos. Int. 2014. 25 (10). 2335-46. Doi: 10.1007/s00198-014-2734-1.

Orford N.R., Bailey M., Bellomo R., Pasco J.A., Cattigan C., Elderkin T., Brennan-Olsen S.L., Cooper D.J., Kotowicz M.A. The associa-tion of time and medications with changes in bone mine­ral Density in the 2 years after critical illness. Crit. Care. 2017. 21 (1). 69. Doi: 10.1186/s13054-017-1657-6.

Grimm G., Vila G., Bieglmayer C., Riedl M., Luger A., Clodi M. Changes in osteopontin and in biomarkers of bone turnover Du­ring hu-man endotoxemia. Bone. 2010. 47 (2). 388-91. Doi: 10.1016/j.bone.2010.04.602.

Griffith D.M., Walsh T.S. Bone loss During critical illness: a skeleton in the closet for the intensive care unit survivor? Crit. Care Med. 2011. 39 (6). 1554-1556. Doi: 10.1097/CCM.0b013e318215beb4.

Klein G.L. Burns. Where Has All the Calcium (and Vitamin D) Gone? Adv. Nutr. 2011. 2 (6). 457-462.

Terzi R., Güven M. Bone Mineral Density After Burn Injury and Its Relation to the Characteristics of Scar Tissue. J. Burn Care Res. 2016. 37 (3). e263-267. Doi: 10.1097/BCR.0000000000000241.

Mayes T., Gottschlich M., Scanlon J., Warden G.D. Four-year review of burns as an etiologic factor in the Development of long bone frac-tures in pediatric patients. J. Burn Care Rehabil. 2003. 24 (5). 279-84. Doi: 10.1097/01.BCR.0000085844.84144.E0.

Mayes T., Gottschlich M.M., Khoury J., Kagan R.J. Investigation of Bone Health Subsequent to Vitamin D Supplementation in Children Following Burn Injury. Nutr. Clin. Pract. 2015. 30 (6). 830-7. Doi: 10.1177/0884533615587720.

Klein G.L., Langman C.B., Herndon D.N. Vitamin D Depletion following burn injury in children: a possible factor in post-burn osteopenia. J. Trauma. 2002. 52 (2). 346-50. Doi: 10.1097/00005373-200202000-00022.

Blay B., Thomas S., Coffey R., Jones L., Murphy C.V. Low Vitamin D Level on Admission for Burn Injury Is Associated With Increased Length of Stay. J. Burn Care Res. 2017. 38 (1). e8-e13. Doi: 10.1097/BCR.0000000000000445.

Amrein K., Schnedl C., Holl A., Riedl R., Christopher K.B., Pachler C. et al. Effect of high-dose vitamin D3 on hospital length of stay in critically ill patients with vitamin D Deficiency: the VITdAL-ICU randomized clinical trial. JAMA. 2014. 312 (15). 1520-1530. Doi: 10.1001/jama.2014.13204.

Martucci G., McNally D., Parekh D., Zajic P., Tuzzolino F., Arcadipane A., Christopher K.B., Dobnig H., Amrein K. Trying to identify who may benefit most from future vitamin D intervention trials: a post hoc analysis from the VITDAL-ICU study excluding the early Deaths. Crit. Care. 2019. 23 (1). 200. Doi: 10.1186/s13054-019-2472-z.

Braun A.B., Gibbons F.K., Litonjua A.A., Giovannucci E., Christopher K.B. Low serum 25-hydroxyvitamin D at critical care initiation is associated with increased mortality. Crit. Care Med. 2012. 40 (1). 63-72. Doi: 10.1097/CCM.0b013e31822d74f3.

Moraes R.B., Friedman G., Wawrzeniak I.C. et al. Vitamin D Deficiency is independently associated with mortality among critically ill patients. Clinics (Sao Paulo). 2015. 70 (5). 326-332. Doi: 10.6061/clinics/2015 (05)04.

Leclair T.R., Zakai N., Bunn J.Y., Gianni M., Heyland D.K., Ardren S.S., Stapleton R.D. Vitamin D Supplementation in Mechanically Ventilated Patients in the Medical Intensive Care Unit. JPEN J. Parenter. Enteral. Nutr. 2019. 43 (8). 1037-1043. Doi: 10.1002/jpen.1520.

Vipul P., Shuchi C., Avinash A., Manish G., Sukriti K., Ved P. Correlation of Serum Vitamin D Level with Mortality in Patients with Sep-sis. Indian. J. Crit. Care Med. 2017. 21 (4). 199-204. Doi: 10.4103/ijccm.IJCCM_192_16.

Amrein K., Zajic P., Schnedl C. et al. Vitamin D status and its association with season, hospital and sepsis mortality in critical illness. Crit. Care. 2014. 18 (2). R47. Doi. 10.1186/cc13790.

de Haan K., Groeneveld A.B., De Geus H.R., Egal M., Struijs A. Vitamin D Deficiency as a risk factor for infection, sepsis and mortality in the critically ill: systematic review and meta-analysis. Crit. Care. 2014. 18 (6). 660. Doi: 10.1186/s13054-014-0660-4.

Dancer R.C., Parekh D., Lax S., D'Souza V., Zheng S., Bassford C.R. et al. Vitamin D Deficiency contributes Directly to the acute res-piratory Distress syndrome (ARDS). Thorax. 2015. 70 (7). 617-24. Doi: 10.1136/thoraxjnl-2014-206680.

Martineau A.R., Jolliffe D.A., Hooper R.L. et al. Vitamin D supplementation to prevent acute respiratory tract infections: systema­tic re-view and meta-analysis of individual participant Data. BMJ. 2017. 356. i6583. Published 2017 Feb 15. Doi: 10.1136/bmj.i6583.

Gauglitz G.G., Herndon D.N., Jeschke M.G. Insulin resistance postburn: underlying mechanisms and current therapeutic strategies. J. Burn Care Res. 2008. 29 (5). 683-94. Doi: 10.1097/BCR.0b013e31818481ce.

Tao S., Yuan Q., Mao L., Chen F.L., Ji F., Cui Z.H. Vitamin D Deficiency causes insulin resistance by provoking oxidative stress in hepatocytes. Oncotarget. 2017. 8 (40). 67605-67613. Doi: 10.18632/oncotarget.18754.

McNally J.D. Vitamin D as a modifiable risk factor in critical illness: questions and answers provided by observational stu­dies. J. Pediatr. (Rio J.). 2014. 90 (2). 99-101. Doi: 10.1016/j.jped.2013.12.002.

Amrein K., Sourij H., Wagner G., Holl A., Pieber T.R., Smolle K.H., Stojakovic T., Schnedl C., Dobnig H. Short-term effects of high-dose oral vitamin D3 in critically ill vitamin D Deficient patients: a randomized, Double-blind, placebo-controlled pilot study. Crit. Care. 2011. 15. R104.

Vieth R. Vitamin D toxicity, policy, and science. J. Bone Mi­ner. Res. 2007. 22 (2). 64-68. Doi: 10.1359/jbmr.07s221.





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